Factors Associated with the Refusal of Direct-Acting Antiviral Agents for the Treatment of Hepatitis C in Taiwan

Abstract

Background and Objectives: Direct-acting antiviral agents (DAA) are a safe and highly effective treatment for hepatitis C virus (HCV) infection. However, the uptake of DAA treatment remains a challenge. This study aims to examine the reasons for DAA refusal among HCV patients covered by the Taiwan National Health Insurance system. Materials and Methods: This retrospective observational study covered the period from January 2009 to December 2019 and was conducted at a single hepatitis treatment center in Taiwan. This study involved chart reviews and phone-based surveys to confirm treatment status and refusal causes. To confirm treatment status, subjects with HCV without treatment records were phone-contacted to confirm treatment status. Patients who did not receive treatment were invited back for treatment. If the patient refused, the reason for refusal was discussed. Results: A total of 3566 patients were confirmed with DAA treatment; 418 patients (179 patients who were lost to contact or refused the survey and 239 patients who completed the survey of DAA refusal) were included in the no-DAA-therapy group. Factors associated with receiving DAAs were hemoglobin levels, hepatitis B virus co-infection, and regular gastroenterology visits. Meanwhile, male sex, platelet levels, and primary care physician visits were associated with DAA refusal. The leading causes of treatment refusal were multiple comorbidities, low health literacy, restricted access to hospitals, nursing home residence, and old age. The rate of DAA refusal remains high (10%). Conclusions: The reasons for treatment refusal are multifactorial, and addressing them requires complex interventions.

Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C?

“…Key assumptions in the decision tree model structure were that, first, for patients who must choose treatment based on the genotyping test results, we hypothesized that 5.8% of patients would be lost due to the absence of genotyping facility or other reasons [ 8 , 26 , 27 ]. Second, 75% of patients who failed initial treatment were assumed to continue treatment with the SOF/VEL/VOX regimen, while those who failed second-line treatment were no longer receiving antiviral therapy [ 28 – 30 ]. Third, due to the short treatment time and efficacy of direct antiviral therapy, which needed only oral medication, we assumed 100% compliance with treatment and patients would not reinfect and relapse after obtaining SVR.…”