P48 Clinical update: ivermectin access for scabies improved through the pharmaceutical benefits scheme change in Australia

Scabies is estimated to affect 455 million people worldwide and is a neglected tropical disease that is endemic in northern Australia. Indigenous communities in northern Australia are reported to have some of the highest rates of scabies in the Pacific, with recent prevalence reported to be as high as 25%, with secondary complications including rheumatic heart disease and poststreptococcal glomerulonephritis. However, the high burden of skin disease is still under-reported and under-represented on the national policy agenda. It is essential to consider public health strategies and therapeutic opportunities to address the high burden of disease and minimize serious secondary complications that contribute to the health and life expectancy gap that exists between aboriginal and Torres Strait Islander people and other Australians. Considering the clinical need of the patient population, the management of scabies in northern Australia highlights the impracticality and tolerability issues experienced, with topical permethrin 5% cream as the sole first-line treatment option and use of ivermectin only as a second-line treatment after treatment failure with permethrin cream. This is especially important as poor medication access and treatment failure are well known to perpetuate a cycle of health inequity in northern Australia. A multistakeholder submission to the Pharmaceutical Benefits Advisory Committee was developed to support a change to the listing of ivermectin on the Pharmaceutical Benefits Scheme (PBS) in Australia, and to recommend ivermectin as a first-line treatment option for the management of scabies in aboriginal and Torres Strait Islander people in Australia. The PBS listing was successfully changed after 9 months of review, and from 1 April 2022, oral ivermectin has been listed as a first-line treatment for the management of scabies in aboriginal and Torres Strait Islander people in Australia. It is anticipated that the change in national prescribing will have a large impact on a small number of Australians who face significant disadvantages and health inequity and will improve access of treatment to manage effectively a condition that disproportionately affects First Nations people in Australia. The successful PBS listing change occurred ahead of the release of the new edition of the Australian clinical guidelines, which at the time of writing are scheduled to be released in early 2023. The updated guidelines will include ivermectin as a co-first-line treatment alongside topical permethrin 5% cream for the management of scabies, in addition to considering an ivermectin-based mass-drug administration programme for endemic regions in which the burden of scabies is estimated to be > 10%, as recommended by the World Health Organization.