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

José Antonio Carrión, Elena Gonzalez-Colominas, Montserrat García-Retortillo, Nuria Cañete, Isabel Cirera, Susanna Coll, Maria Dolors Giménez, Carmen Márquez, Victoria Martin-Escudero, Pere Castellví, Ricard Navinés, Juan Ramon Castaño, Josep Anton Galeras, Esther Salas, Felipe Bory, Rocío Martín-Santos, Ricard Solà

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29 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)926-933
JournalJournal of Hepatology
Volume59
Issue number5
DOIs
Publication statusPublished - 1 Nov 2013

Keywords

  • Cost-effectiveness
  • Hepatitis
  • Programme
  • Response
  • Treatment

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