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A comparison of hepatitis C treatment and outcomes at academic, private and Veterans' Affairs treatment centres
Author(s) -
Jensen D. M.,
Cotler S. J.,
Lam H.,
Harb G.,
Shillington A.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2003.01817.x
Subject(s) - veterans affairs , medicine , ribavirin , private practice , hepatitis c , hepatitis c virus , retrospective cohort study , multivariate analysis , family medicine , immunology , virus
Summary Background : Currently, there is a lack of published data examining hepatitis C treatment practices in different care settings. Aim : To provide data describing treatment practices for patients with hepatitis C virus infection in actual clinical practice, and to examine clinical outcomes in patients treated with interferon alpha‐2b/ribavirin combination therapy in academically affiliated centres, private treatment centres and Veterans' Affairs treatment centres. Methods : This multi‐centre, retrospective, cohort study of 231 patients examined hepatitis C virus treatment practices in patients receiving interferon alpha‐2b from January 1997 to May 2001 and explored outcomes in academically affiliated, private and Veterans' Affairs centres. Results : Differences in treatment practice and use of diagnostic procedures were found. Genotype testing was under‐utilized in non‐academic sites (academic centres, 79.2%; private centres, 33.7%; Veterans' Affairs centres, 35.9%; P < 0.001). Liver biopsies were performed less often in private sites (academic centres, 95.8%; private centres, 80.0%; Veterans' Affairs centres, 92.2%; P < 0.01). End‐of‐treatment viral response (academic centres, 40.0%; private centres, 31.3%; Veterans' Affairs centres, 17.2%; P < 0.05) was lower than that found in published trial data. Multivariate analysis revealed genotype 1 as the single significant predictor of treatment failure ( P < 0.01). Conclusions : Outside of the academic setting, there is significantly less diagnostic work‐up performed prior to the initiation of hepatitis C virus therapy. This suggests a need for a standardization of care across treatment settings.