Huge Gap Between Clinical Efficacy and Community Effectiveness in the Treatment of Chronic Hepatitis C A Nationwide Survey in Taiwan

• Published in: Medicine (Baltimore) Vol. 94; no. 13; p. e690
• Main Authors: Yu, Ming-Lung, Yeh, Ming-Lun, Tsai, Pei-Chien, Huang, Ching-I., Huang, Jee-Fu, Huang, Chung-Feng, Hsieh, Meng-Hsuan, Liang, Po-Cheng, Lin, Yi-Hung, Hsieh, Ming-Yen, Lin, Wen-Yi, Hou, Nai-Jen, Lin, Zu-Yau, Chen, Shinn-Cherng, Dai, Chia-Yen, Chuang, Wan-Long, Chang, Wen-Yu
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.04.2015
• Subjects: Adult; Aged; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Hepatitis C, Chronic - therapy; Humans; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Male; Medication Adherence; Middle Aged; Observational Study; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Prevalence; Prospective Studies; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Ribavirin - administration & dosage; Ribavirin - adverse effects; Ribavirin - therapeutic use; Taiwan - epidemiology
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000000690

Peginterferon/ribavirin provides a substantially high treatment efficacy for chronic hepatitis C virus (HCV) infections in Asians. Whether the clinical efficacy can be translated to community effectiveness remains unclear. The disease awareness, treatment accessibility, recommendations, acceptance, and barriers to anti-HCV treatment were explored to clarify the issue with a 3-step nationwide investigation in Taiwan. A crude HCV-infected population was estimated using databases from 3 large-scale surveillance studies and age-/geographic-specific population database. HCV awareness and accessibility were investigated at the patient level in 58,129 residents. The recommendations/acceptances and barriers to treatment at the provider level were evaluated using a prospective, nationwide approach to 89 gastroenterologists/hepatologists. The estimated 10-year interval age-adjusted anti-HCV-seropositive population is 745,109 (3.28%), with an anticipated HCV-viremic population of 554,361. Of anti-HCV-seropositive subjects, 36.2% had disease awareness. Among those with awareness, 39.6% had accessibility. The recommendation/acceptance rate of antiviral therapy was 70.6%. The treatment rate was 10.1% and 13.7% for the anti-HCV-seropositive and HCV-viremic population, respectively. With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment. The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%). Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan. Increasing disease awareness/treatment accessibility and introducing new therapeutic strategies with high tolerability are warranted.