Impact of hepatitis B immunoglobulin mode of administration on treatment experiences of patients after liver transplantation: Results from an online survey

Abstract

Background: Hepatitis B immunoglobulin (HBIG) in combination with a potent nucleos(t)ide analog is considered the standard of care for prophylaxis against hepatitis B virus (HBV) reinfection after liver transplantation for HBV-associated disease.

Aim: To evaluate patients' satisfaction, preferences, and requirements for subcutaneous (SC), intramuscular (IM), and intravenous (IV) HBIG treatments.

Methods: A self-completion, cross-sectional, online, 22-question survey was conducted to examine perceptions and satisfaction with current HBIG treatment in adults receiving HBIG treatment following liver transplantation for HBV-associated disease in France, Italy, and Turkey. Hypothetical HBIG products with different administration modes were evaluated using target product profile assessment and a conjoint (trade-off) exercise.

Results: Ninety patients were enrolled; 32%, 17%, and 51% were SC, IM, and IV HBIG users, respectively. Mean duration of treatment was 36.2 months. SC HBIG had the least negative impact on emotional well-being and social life and was perceived as the most convenient, easiest to administer, least painful, and had the highest self-rating of treatment compliance. More IM HBIG users than SC or IV HBIG users reported that administration frequency was excessive (67%, 28%, and 28%, respectively). In the target product profile assessment, 76% of patients were likely to use hypothetical SC HBIG. In the conjoint exercise, administration route, frequency, and duration were key drivers of treatment preferences.

Conclusion: Ease, frequency, duration, and side effects of HBIG treatment administration were key drivers of treatment preferences, and SC HBIG appeared advantageous over IM and IV HBIG for administration ease, convenience, and pain. A hypothetical SC HBIG product elicited a favorable response. Patient demographics, personal preferences, and satisfaction with HBIG treatment modalities may influence long-term treatment compliance.

Keywords: Hepatitis B immunoglobulin; Intramuscular; Intravenous; Liver transplantation; Patient satisfaction; Subcutaneous.

Figure 1

Current hepatitis B immunoglobulin treatment. A: Life aspects affected; B: Patient experience. ^aP ≤ 0.05 denotes statistically significant difference vs intravenous hepatitis B immunoglobulin. ¹Issues caused by treatment. HBIG: Hepatitis B immunoglobulin; IM: Intramuscular; IV: Intravenous; SC: Subcutaneous.

Figure 2

Challenges faced by patients using hepatitis B immunoglobulin treatment. ^aP ≤ 0.05 denotes statistically significant difference vs intravenous hepatitis B immunoglobulin. HBIG: Hepatitis B immunoglobulin; IM: Intramuscular; IV: Intravenous; SC: Subcutaneous.

Figure 3

Satisfaction with current hepatitis B immunoglobulin treatment. Percentages are rounded to the nearest whole numbers therefore may not add up to 100% for each column. ^aP ≤ 0.05 denotes statistically significant difference vs intravenous hepatitis B immunoglobulin. ¹Percentages calculated as a proportion of 89 patients who responded to this question. ²Percentages calculated as a proportion of 45 patients who responded to this question. HBIG: Hepatitis B immunoglobulin; IM: Intramuscular; IV: Intravenous; SC: Subcutaneous.

Figure 4

Factors influencing choice of most appropriate hepatitis B immunoglobulin treatment. ^aP ≤ 0.05 denotes statistically significant difference vs intravenous hepatitis B immunoglobulin. HBIG: Hepatitis B immunoglobulin; IM: Intramuscular; IV: Intravenous; SC: Subcutaneous.

Figure 5

Statements describing patients’ perceptions of ‘convenience’ regarding hepatitis B immunoglobulin treatments. Percentages refer to the proportion of patients who, unprompted, mentioned the specific aspects listed. HBIG: Hepatitis B immunoglobulin; IM: Intramuscular; IV: Intravenous; SC: Subcutaneous.