- 作者：Jos¨¦ Antonio Carri¨®n ; Elena Gonzalez-Colominas ; Montserrat Garc¨ªa-Retortillo ; Nuria Ca?ete ; Isabel Cirera ; Susanna Coll ; Maria Dolors Gim¨¦nez ; Carmen M¨¢rquez ; Victoria Martin-Escudero ; Pere Castellv¨ª ; Ricard Navin¨¦s ; Juan Ramon Casta?o ; Josep Anton Galeras ; Esther Salas ; Felipe Bory ; Roc¨ªo Mart¨ªn-Santos ; Ricard Sol¨¤
- 关键词：CHC ; chronic hepatitis C ; HCC ; hepatocellular carcinoma ; SVR ; sustained virological response ; MSP ; multidisciplinary support programme ; pegIFN ; pegylated interferon ; DAA ; direct-acting antivirals ; TVR ; telaprevir ; BOC ; boceprevir ; RBV ; ribavirin ; HCV ; hep
- 刊名：Journal of Hepatology
- 出版年：2013
- 出版时间：November, 2013
- 年：2013
- 卷：59
- 期：5
- 页码：926-933
- 全文大小：765 K
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.