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Abstract

Background & aims: Treatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C. Methods: We conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity. Results: We included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1–30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04), region (Europe vs. North America p = 0.004), and data source (clinical chart review vs. administrative database, p = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care. Conclusions: Only one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.

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P., V., M., J., M.H., L., P., N., S., T., J.-F., H., … M.H., N. (2017). Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis. PLoS ONE, 12(9). https://doi.org/10.1371/journal.pone.0183851 LK  - http://sfx.umd.edu/hs?sid=EMBASE&issn=19326203&id=doi:10.1371%2Fjournal.pone.0183851&atitle=Regional+differences+in+treatment+rates+for+patients+with+chronic+hepatitis+C+infection%3A+Systematic+review+and+meta-analysis&stitle=PLoS+ONE&title=PLoS+ONE&volume=12&issue=9&spage=&epage=&aulast=Vutien&aufirst=Philip&auinit=P.&aufull=Vutien+P.&coden=POLNC&isbn=&pages=-&date=2017&auinit1=P&auinitm=

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