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Huge gap between clinical efficacy and community effectiveness in the treatment of chronic hepatitis C: a nationwide survey in Taiwan.

Yu ML, Yeh ML, Tsai PC, Huang CI, Huang JF, Huang CF, Hsieh MH, Liang PC, Lin YH, Hsieh MY, Lin WY, Hou NJ, Lin ZY, Chen SC, Dai CY, Chuang WL, Chang WY - Medicine (Baltimore) (2015)

Bottom Line: With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment.The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%).Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan.

View Article: PubMed Central - PubMed

Affiliation: From the Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital (Ming-Lung Yu, Ming-Lun Yeh, P-CT, J-FH, C-FH, P-CL, Y-HL, M-YH, Z-YL, S-CC, C-YD, W-LC, W-YC); Faculty of Internal Medicine, College of Medicine, and Graduate Institute of Clinical Medicine, and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University (Ming-Lung Yu, J-FH, C-FH, M-HH, Z-YL, S-CC, C-YD, W-LC); Institute of Biomedical Sciences, National Sun Yat-Sen University (Ming-Lung Yu); Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (C-IH, N-JH); Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital (C-FH); Department of Preventive Medicine, Kaohsiung Medical University Hospital (M-HH); Department of Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-YL); and Taiwan Liver Research Foundation, Kaohsiung, Taiwan (W-YC).

ABSTRACT
Peginterferon/ribavirin provides a substantially high treatment efficacy for chronic hepatitis C virus (HCV) infections in Asians. Whether the clinical efficacy can be translated to community effectiveness remains unclear. The disease awareness, treatment accessibility, recommendations, acceptance, and barriers to anti-HCV treatment were explored to clarify the issue with a 3-step nationwide investigation in Taiwan. A crude HCV-infected population was estimated using databases from 3 large-scale surveillance studies and age-/geographic-specific population database. HCV awareness and accessibility were investigated at the patient level in 58,129 residents. The recommendations/acceptances and barriers to treatment at the provider level were evaluated using a prospective, nationwide approach to 89 gastroenterologists/hepatologists. The estimated 10-year interval age-adjusted anti-HCV-seropositive population is 745,109 (3.28%), with an anticipated HCV-viremic population of 554,361. Of anti-HCV-seropositive subjects, 36.2% had disease awareness. Among those with awareness, 39.6% had accessibility. The recommendation/acceptance rate of antiviral therapy was 70.6%. The treatment rate was 10.1% and 13.7% for the anti-HCV-seropositive and HCV-viremic population, respectively. With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment. The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%). Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan. Increasing disease awareness/treatment accessibility and introducing new therapeutic strategies with high tolerability are warranted.

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Related in: MedlinePlus

The reasons for not receiving antiviral therapy by age and clinic characteristics. (A) Fear of adverse effects. (B) Ineligible for insurance reimbursement. (C) Ineligible for major disorders. (D) Therapy unawareness. ∗ Adjusted P value: the effects of age/clinic characteristics for those reasons without receiving antiviral therapy after adjustment for risk factors. † The number (n/N) was showed in the parentheses.
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Figure 3: The reasons for not receiving antiviral therapy by age and clinic characteristics. (A) Fear of adverse effects. (B) Ineligible for insurance reimbursement. (C) Ineligible for major disorders. (D) Therapy unawareness. ∗ Adjusted P value: the effects of age/clinic characteristics for those reasons without receiving antiviral therapy after adjustment for risk factors. † The number (n/N) was showed in the parentheses.

Mentions: The elderly patients had a 2.3-fold higher proportion of patient concern for fear of AEs (OR = 2.31 and adjusted P for trend test = 0.001) (Figure 3A andTable 2), a 0.35-fold lower proportion of ineligibility for insurance reimbursement criteria of HCV therapy (OR = 0.35 and adjusted P for trend test <0.0001) (Figure 3B and Table 2) and a 2.5-fold higher proportion of major systemic disorders than their younger counterparts (OR = 2.50 and adjusted P for trend test <0.0001; Figure 3C and Table 2), especially in major hematological disorders (leukopenia, anemia, or thrombocytopenia) (P = 0.031) and systemic disorders (such as major psychological disorders, poorly controlled diabetes, and cardiovascular diseases) (P < 0.0001).


Huge gap between clinical efficacy and community effectiveness in the treatment of chronic hepatitis C: a nationwide survey in Taiwan.

Yu ML, Yeh ML, Tsai PC, Huang CI, Huang JF, Huang CF, Hsieh MH, Liang PC, Lin YH, Hsieh MY, Lin WY, Hou NJ, Lin ZY, Chen SC, Dai CY, Chuang WL, Chang WY - Medicine (Baltimore) (2015)

The reasons for not receiving antiviral therapy by age and clinic characteristics. (A) Fear of adverse effects. (B) Ineligible for insurance reimbursement. (C) Ineligible for major disorders. (D) Therapy unawareness. ∗ Adjusted P value: the effects of age/clinic characteristics for those reasons without receiving antiviral therapy after adjustment for risk factors. † The number (n/N) was showed in the parentheses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554019&req=5

Figure 3: The reasons for not receiving antiviral therapy by age and clinic characteristics. (A) Fear of adverse effects. (B) Ineligible for insurance reimbursement. (C) Ineligible for major disorders. (D) Therapy unawareness. ∗ Adjusted P value: the effects of age/clinic characteristics for those reasons without receiving antiviral therapy after adjustment for risk factors. † The number (n/N) was showed in the parentheses.
Mentions: The elderly patients had a 2.3-fold higher proportion of patient concern for fear of AEs (OR = 2.31 and adjusted P for trend test = 0.001) (Figure 3A andTable 2), a 0.35-fold lower proportion of ineligibility for insurance reimbursement criteria of HCV therapy (OR = 0.35 and adjusted P for trend test <0.0001) (Figure 3B and Table 2) and a 2.5-fold higher proportion of major systemic disorders than their younger counterparts (OR = 2.50 and adjusted P for trend test <0.0001; Figure 3C and Table 2), especially in major hematological disorders (leukopenia, anemia, or thrombocytopenia) (P = 0.031) and systemic disorders (such as major psychological disorders, poorly controlled diabetes, and cardiovascular diseases) (P < 0.0001).

Bottom Line: With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment.The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%).Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan.

View Article: PubMed Central - PubMed

Affiliation: From the Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital (Ming-Lung Yu, Ming-Lun Yeh, P-CT, J-FH, C-FH, P-CL, Y-HL, M-YH, Z-YL, S-CC, C-YD, W-LC, W-YC); Faculty of Internal Medicine, College of Medicine, and Graduate Institute of Clinical Medicine, and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University (Ming-Lung Yu, J-FH, C-FH, M-HH, Z-YL, S-CC, C-YD, W-LC); Institute of Biomedical Sciences, National Sun Yat-Sen University (Ming-Lung Yu); Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (C-IH, N-JH); Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital (C-FH); Department of Preventive Medicine, Kaohsiung Medical University Hospital (M-HH); Department of Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-YL); and Taiwan Liver Research Foundation, Kaohsiung, Taiwan (W-YC).

ABSTRACT
Peginterferon/ribavirin provides a substantially high treatment efficacy for chronic hepatitis C virus (HCV) infections in Asians. Whether the clinical efficacy can be translated to community effectiveness remains unclear. The disease awareness, treatment accessibility, recommendations, acceptance, and barriers to anti-HCV treatment were explored to clarify the issue with a 3-step nationwide investigation in Taiwan. A crude HCV-infected population was estimated using databases from 3 large-scale surveillance studies and age-/geographic-specific population database. HCV awareness and accessibility were investigated at the patient level in 58,129 residents. The recommendations/acceptances and barriers to treatment at the provider level were evaluated using a prospective, nationwide approach to 89 gastroenterologists/hepatologists. The estimated 10-year interval age-adjusted anti-HCV-seropositive population is 745,109 (3.28%), with an anticipated HCV-viremic population of 554,361. Of anti-HCV-seropositive subjects, 36.2% had disease awareness. Among those with awareness, 39.6% had accessibility. The recommendation/acceptance rate of antiviral therapy was 70.6%. The treatment rate was 10.1% and 13.7% for the anti-HCV-seropositive and HCV-viremic population, respectively. With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment. The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%). Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan. Increasing disease awareness/treatment accessibility and introducing new therapeutic strategies with high tolerability are warranted.

Show MeSH
Related in: MedlinePlus