Persistence with hepatitis C therapy in the Department of Veterans Affairs

Iqbal, S. U.; Cunningham, Fran; Lee, A.; Miller, Diane; Li, N.‐C.; Cheung, Ramsey; Kazis, Lewis E.

doi:10.1111/j.1365-2710.2008.00912.x

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Although comparisons to other studies are difficult because of differences in methodology, the mean treatment duration of 215 days is consistent with estimates from other studies of 172–240 days [ 15 , 16 , 19 , 30 ]. In a retrospective cohort study of Veterans Affairs patients, two of the most common TECs we identified, anemia and neutropenia, were associated with lower persistence with PEG-IFN-alfa/ribavirin treatment (mean 172 days) [ 30 ]. Similar to patients in our study, the investigators identified patients with anemia and neutropenia through both ICD-9-CM codes and by identifying medication use (specifically the use of growth factors).…”

Section: Discussionsupporting

confidence: 84%

Incidence and cost of treatment-emergent comorbid events in insured patients with chronic hepatitis C virus infection: a retrospective cohort study

Sapra

Chang

Broder

et al. 2014

BMC Health Serv Res

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BackgroundTreatment-emergent comorbid events (TECs) are common In patients initiating treatment with pegylated interferon alpha (PEG-IFN-alfa) and ribavirin for chronic hepatitis C virus (HCV) infection. The purpose of this study was to estimate the incidence and incremental cost of these events.MethodsIn a retrospective cohort analysis of healthcare claims, we studied patients with HCV who were newly treated with PEG-IFN-alfa/ribavirin between 2006 and 2008. TECs were defined by new medical/pharmacy claims for predefined conditions in the 12 months after treatment initiation. The net incremental cost of the TECs was the difference between baseline and follow-up costs for these comorbidities and their treatment, excluding PEG-IFN-alfa/ribavirin costs.ResultsOf 3,795 newly treated patients, 1,269 (mean age 50.2, 36.2% female) met the selection criteria. New TECs were common, with 61.6% of patients having ≥1 event. Anemia was identified in 29.2% of patients, fatigue in 16.4%, depression in 11.5%, and neutropenia in 11.0%. The mean incremental cost for the predefined TEC in the postindex period was $6,377 ($2,782 for medical and $3,595 for pharmacy claims).ConclusionsIn an insured US cohort with chronic HCV infection, TECs with PEG-IFN-alfa/ribavirin were common and increased costs by approximately $6,000 per treated patient. This estimate may be conservative because it excludes indirect costs. Costs might increase with new regimens that include a protease inhibitor because additional TECs may be expected. Better-tolerated therapies that reduce the financial burden on the healthcare system and improve patient experience are needed.

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Section: Discussionsupporting

confidence: 84%

Incidence and cost of treatment-emergent comorbid events in insured patients with chronic hepatitis C virus infection: a retrospective cohort study

Sapra

Chang

Broder

et al. 2014

BMC Health Serv Res

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“…20,21 However, the difference in persistence rates observed between the two agents may not translate into any meaningful differences in clinical outcomes. 30 The results of the current analysis are in accord with those from the VA study, 30 as persistence rates were likely to be higher with peginterferon alfa-2a than with peginterferon alfa2b; however, further trials and studies Table 3. are required to explore whether such persistence differences have clinical significance.…”

Section: Discussionsupporting

confidence: 85%

“…30 It is possible that the higher persistence rates observed with peginterferon alfa-2a versus peginterferon alfa-2b may be attributable to the differences in the pharmacokinetic and tolerability profiles between the agents. In fact, higher treatment discontinuation rates have been observed with peginterferon alfa-2b than with peginterferon alfa-2a.…”

Section: Discussionmentioning

confidence: 98%

Treatment persistence in and cost of therapy for patients with chronic hepatitis C: Peginterferon alfa-2a plus ribavirin versus peginterferon alfa-2b plus ribavirin

Brixner

Ye²,

Chu³

et al. 2009

American Journal of Health-System Pharmacy

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“…In a regional cohort of veterans undergoing substance abuse treatment, early discontinuation estimates were 60% among G1/4 patients and 27-32% among G2/3 patients [15]. In two U.S. cohorts of primarily genotype 1-infected veterans treated with interferon or Peg-IFN, more than 75% failed to complete 48 weeks of treatment [16,17], though discontinuers are not distinguished by their reason for discontinuation. Backus et al report cumulative days’ supply instead of weeks on treatment for genotype 1-, 2-, and 3-infected veterans; 43% of genotype 1 patients, 30% of genotype 2 patients, and 25% of genotype 3 patients did not have 100% cumulative days’ supply [18].…”

Section: Discussionmentioning

confidence: 99%

High rates of early treatment discontinuation in hepatitis C-infected US veterans

LaFleur

Hoop²,

Morgan

et al. 2014

BMC Res Notes

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BackgroundPatients with chronic hepatitis C (HCV) frequently discontinued dual therapy with pegylated interferon alfa (Peg-IFN) plus ribavirin (RBV) before reaching the recommended duration of 48 or 24 weeks for genotypes (G) 1/4 or 2/3, respectively. We quantified rates of discontinuation despite efficacy (non-LOE) versus lack of efficacy (LOE) versus discontinuation for unknown reasons in a national database of United States veterans.MethodsWe identified a population-based cohort of U.S. veterans with encounters from 2004 through 2009 who had lab-confirmed HCV infection and initiated therapy with Peg-IFN plus RBV in Veterans Health Administration medical centers. Pharmacy data were used to determine therapy duration, defined as the sum of Peg-IFN days supplied. Patients “discontinued” if they failed to receive at least 44 (G1/4) or 20 weeks (G2/3) of therapy. We classified discontinuations as due to non-LOE, LOE, or unknown reasons using a classification rule based on treatment duration and laboratory confirmed response.ResultsOf 321,238 diagnosed HCV patients during the evaluation period, 9.7% initiated therapy and 6.4% met all other inclusion criteria. 54.9% of patients discontinued early; of these, 41.2% discontinued due to non-LOE reasons, 12.5% discontinued for LOE reasons, and 46.3% discontinued for unknown reasons. Among non-LOE discontinuers, most (60.1%) discontinued in the first 4 weeks of therapy, which constitutes 13.6% of all treated patients.ConclusionsWe observed a high proportion of early discontinuations with dual-therapy regimens in a national cohort of HCV-infected veterans. If this trend persists in the triple-therapy era, then efforts must be undertaken to improve adherence.

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Persistence with hepatitis C therapy in the Department of Veterans Affairs

Cited by 5 publications

References 22 publications

Incidence and cost of treatment-emergent comorbid events in insured patients with chronic hepatitis C virus infection: a retrospective cohort study

Incidence and cost of treatment-emergent comorbid events in insured patients with chronic hepatitis C virus infection: a retrospective cohort study

Treatment persistence in and cost of therapy for patients with chronic hepatitis C: Peginterferon alfa-2a plus ribavirin versus peginterferon alfa-2b plus ribavirin

High rates of early treatment discontinuation in hepatitis C-infected US veterans

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