Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis

Abstract

Background & aimsTreatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C.MethodsWe conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity.ResultsWe included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1–30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04), region (Europe vs. North America p = 0.004), and data source (clinical chart review vs. administrative database, p = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care.ConclusionsOnly one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.

Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study

“…However, at present, public health programmes and access to health-care services for people with HCV lags behind other comparable infectious diseases, such as HIV or malaria 1 . The provision of direct-acting antiviral therapies in patients with HCV infection remains low on the global scale, with only one in 15 patients 1 currently being treated, the majority of whom reside in high-income countries 81, 82. To have the greatest impact on HCV morbidity and mortality, the delivery of curative HCV treatment needs to be coupled with efficient health systems to provide chronic care services for patients with both hepatic and extrahepatic complications of HCV.…”

Predicting Treatment Failure for Initiators of Hepatitis C Virus Treatment in the era of Direct-Acting Antiviral Therapy

“…For example, there is currently not an evidence-based minimum threshold of adherence recommended to achieve SVR, but it is likely a major contributor to nonachievement of SVR (Younossi et al, 2016). Additionally, since many patients are undiagnosed, untreated, and experience difficulty accessing HCV specialists, there is a need for HCV management in the primary care setting, which warrants further investigation into the association of treatment failure with clinic and provider characteristics (Vutien et al, 2017).…”

The American Cancer Society 2035 challenge goal on cancer mortality reduction

“…Factors that are thought to contribute to this increase include the obesity epidemic, the high prevalence of chronic hepatitis C virus (HCV) infection among baby boomers, and an increase in alcohol consumption . The relatively new treatments for HCV infection can attenuate or reverse the rising liver cancer rates, although the drugs have yet to be disseminated widely because of their high cost . It is estimated that less than 20% of Americans diagnosed with HCV infection are treated, and the majority of those with HCV infection have not been diagnosed .…”

“…The relatively new treatments for HCV infection can attenuate or reverse the rising liver cancer rates, although the drugs have yet to be disseminated widely because of their high cost . It is estimated that less than 20% of Americans diagnosed with HCV infection are treated, and the majority of those with HCV infection have not been diagnosed . Cancer of the uterine corpus is the malignancy most associated with obesity and physical inactivity, and there is an opportunity to halt or reverse the unfavorable mortality trend of pancreatic, liver, and endometrial cancers through individual and community actions to promote healthful lifestyles, such as achieving and maintaining a healthy body weight, being physically active, and consuming a healthy diet.…”