Managing expense and expectation in a treatment revolution: Problematizing prioritisation through an exploration of hepatitis C treatment 'benefit'
Managing expense and expectation in a treatment revolution: Problematizing prioritisation through an exploration of hepatitis C treatment 'benefit'
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DOI：
10.1016/j.drugpo.2017.03.015
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发表时间：
2017-09-01
影响因子：
4.4
通讯作者：
Harris, Magdalena
中科院分区：
文献类型：
--
作者：
Harris, Magdalena
背景：直接作用抗病毒药物（DAA）已经改变了丙型肝炎（HCV）的治疗前景。然而，并非所有人都能获得这些高效药物。在DAA配给的背景下，建议临床医生“管理患者对HCV治愈益处的期望”。该指令特别适用于肝损伤最小的人和那些谁已经停止注射：人口否定在当代的优先debrides.Methods：本文从事的假设支持HCV治疗优先话语，探讨从患者的角度来看治疗“效益”的概念。数据来自一项定性纵向研究，该研究探讨了2012-2015年的治疗过渡和决策。参与者包括28名HCV感染者，10名治疗提供者和8名利益相关者，总部设在英国伦敦。在两家HCV治疗医院进行了100小时的临床观察。有关治疗的期望和结果的主题分析告知this paper.Results：22名参与者开始治疗。大多数无法获得DAA的患者选择立即开始干扰素治疗，而不是等待。与会者占治疗的紧迫性有关的三个相互关联的叙述的希望和期望。HCV治疗承诺：社会重新连接;社会救赎和恢复“正常”。对于许多成功的治疗结果，这些好处似乎是realized.Conclusion：DAA时代预示着一个话语的转变：从“管理[干扰素]的风险和困难”到“管理[DAA]的费用和期望”。呼吁“管理患者对HCV治愈益处的期望”仅基于临床益处，否定了HCV感染的社会影响。在治疗优先次序辩论中通常阐述的公共卫生优先事项与人们在日常生活中管理疾病的优先事项并不一致。在这场“治疗革命”中，需要认识到感染病毒的多种公众以及不符合人口健康状况的人的治疗需求。(C)2017爱思唯尔B. V.保留所有权利。
Background: Direct-acting antivirals (DAAs) have transformed the hepatitis C (HCV) treatment landscape. These highly effective drugs are, however, not available to all. In a context of DAA rationing, clinicians are advised to "manage patient expectations" about the benefits of a HCV cure. This directive particularly pertains to people with minimal liver damage and those who have ceased injecting: populations negated in contemporary prioritisation debates.Methods: This paper engages with the assumptions underpinning HCV treatment prioritisation discourses to explore the concept of treatment 'benefit' from patient perspectives. Data are from a qualitative longitudinal study exploring treatment transitions and decision-making from 2012-2015. Participants comprised 28 people living with HCV, ten treatment providers and eight stakeholders, based in London, United Kingdom (UK). One hundred hours of clinic observations were conducted at two HCV treatment hospitals. Thematic analyses pertaining to treatment expectation and outcome inform this paper.Results: Twenty-two participants commenced treatment. The majority who were unable to access DAAs chose to commence interferon-based treatment immediately rather than wait. Participants accounted for treatment urgency in relation to three interrelated narratives of hope and expectation. HCV treatment promised: social reconnection; social redemption and a return to 'normality'. For many with successful treatment outcomes, these benefits appeared to be realised.Conclusion: The DAA era heralds a discursive shift: from 'managing [interferon] risk and difficulty' to 'managing [DAA] expense and expectation'. Calls to 'manage patient expectations' about the benefits of HCV cure are predicated on clinical benefits only, negating the social impacts of living with HCV. The public health priorities commonly articulated in treatment prioritisation debates are not consistent with those of people managing illness in their daily lives. During this 'treatment revolution' there is a need to be cognisant of the multiple publics living with the virus and the treatment needs of those who do not fit population-health scenarios. (C) 2017 Elsevier B.V. All rights reserved.