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

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.

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.