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Hepatitis C treatment completion rates in routine clinical care
Author(s) -
Butt Adeel A.,
McGinnis Kathleen A.,
Skanderson Melissa,
Justice Amy C.
Publication year - 2010
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2009.02156.x
Subject(s) - medicine , veterans affairs , hepatitis c , odds ratio , pharmacy , confidence interval , comorbidity , cohort , depression (economics) , hepatitis c virus , coinfection , immunology , human immunodeficiency virus (hiv) , family medicine , virus , economics , macroeconomics
Background: Treatment completion rates for hepatitis C virus (HCV) infection in clinical practice settings are unknown. Methods: We assembled a national cohort of HCV‐infected veterans‐in‐care from 1998 to 2003, using the VA National Patient Care Database for demographical/clinical information, Pharmacy Benefits Management database for pharmacy records and the Decision Support Systems database for laboratory data. We used logistic regression to determine the factors predicting treatment non‐completion for HCV. Results: We identified 134 934 HCV‐infected veterans of whom 16 043 [11.9%; 95% confidence interval (CI) 11.7–12.1] were prescribed treatment for HCV. Among the 10 641 veterans with >1 year of follow‐up, 2396 (22.5%; 95% CI 21.7–23.3) completed a 48‐week course. Non‐completers were more likely to have pre‐treatment anaemia, coronary artery disease, depression, substance abuse, used standard interferon, higher comorbidity count, and been treated at a low‐volume treatment site (defined as sites initiating HCV treatment for <200 individuals). In multivariable analyses, treatment completion was positively associated with pegylated interferon use [odds ratio (OR) 1.59, 95% CI 1.40–1.80] and site treatment volume (OR 1.87, 95% CI 1.56–2.24 for sites initiating treatment for >200 individuals) and negatively associated with pre‐treatment anaemia (OR 0.68, 95% CI 0.58–0.80 for haemoglobin 10–14 g/dl) and depression (OR 0.78, 95% CI 0.69–0.89). Human immunodeficiency virus coinfection and minority race were not associated with failing to complete treatment. Conclusions: Among veterans‐in‐care with known HCV, 11.9% initiate therapy of whom 22.5% (one in 56 with known HCV infection) complete a 48‐week course of treatment. Higher completion rates among higher volume treatment sites suggest that some factors associated with non‐completion (pre‐treatment depression and anaemia), may be modifiable with experience.