A multidisciplinary support programme increases the efficiency of pegylated interferon alfa-2a and ribavirin in hepatitis C

J Hepatol. 2013 Nov;59(5):926-33. doi: 10.1016/j.jhep.2013.06.019. Epub 2013 Jun 26.

Carrión JA, Gonzalez-Colominas E, García-Retortillo M, Cañete N, Cirera I, Coll S, Giménez MD, Márquez C, Martin-Escudero V, Castellví P, Navinés R, Castaño JR, Galeras JA, Salas E, Bory F, Martín-Santos R, Solà R.

Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain. Electronic address: 95565@parcdesalutmar.cat.

Abstract

BACKGROUND & AIMS: Adherence to antiviral treatment is important to achieve sustained virological response (SVR) in chronic hepatitis C (CHC). We evaluated the efficiency of a multidisciplinary support programme (MSP), based on published HIV treatment experience, to increase patient adherence and the efficacy of pegylated interferon alfa-2a and ribavirin in CHC.

METHODS: 447 patients receiving antiviral treatment were distributed into 3 groups: control group (2003-2004, n=147), MSP group (2005-2006, n=131), and MSP-validation group (2007-2009, n=169). The MSP group included two hepatologists, two nurses, one pharmacist, one psychologist, one administrative assistant, and one psychiatrist. Cost-effectiveness analysis was performed using a Markov model.

RESULTS: Adherence and SVR rates were higher in the MSP (94.6% and 77.1%) and MSP-validation (91.7% and 74.6%) groups compared to controls (78.9% and 61.9%) (p<0.05 in all cases). SVR was higher in genotypes 1 or 4 followed by the MSP group vs. controls (67.7% vs. 48.9%, p=0.02) compared with genotypes 2 or 3 (87.7% vs. 81.4%, p=n.s.). The MSP was the main predictive factor of SVR in patients with genotype 1. The rate of adherence in patients with psychiatric disorders was higher in the MSP groups (n=95, 90.5%) compared to controls (n=28, 75.7%) (p=0.02). The cost per patient was € 13,319 in the MSP group and € 16,184 in the control group. The MSP group achieved more quality-adjusted life years (QALYs) (16.317 QALYs) than controls (15.814 QALYs) and was dominant in all genotypes.

CONCLUSIONS: MSP improves patient compliance and increases the efficiency of antiviral treatment in CHC, being cost-effective.

Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

KEYWORDS: 95% CI, 95% confidence interval, ALT, ANC, BOC, CHC, Cost-effectiveness, DAA, EOT, EPO, G-CSF, HADS, HBV, HCC, HCV, HIV, Hb, Hepatitis, ICER, MSP, NR, OR, PCR, PHQ, PLT, Programme, QALY, RBV, Response, SE, SVR, TVR, Treatment, ULN, absolute neutrophil count, alanine aminotransferase, boceprevir, chronic hepatitis C, direct-acting antivirals, end of treatment, erythropoietin, granulocyte colony-stimulating factor, haemoglobin, hepatitis B virus, hepatitis C virus, hepatocellular carcinoma, hospital anxiety and depression scale, human immunodeficiency virus, incremental cost-effectiveness ratio, multidisciplinary support programme, non-responders, odds ratio, patient health questionnaires, pegIFN, pegylated interferon, polymerase chain reaction, potentially life threatening, quality-adjusted life year, ribavirin, standard error, sustained virological response, telaprevir, upper limit of normal

PMID: 23811030 [PubMed - in process]

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