Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection.
Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection.
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新诊断的丙型肝炎患者的早期治疗接受情况和丙型肝炎治疗的成本负担，特别关注艾滋病毒合并感染。
DOI：
10.1007/s10620-019-06037-z
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发表时间：
2020
影响因子：
3.1
通讯作者：
Park,Haesuk
中科院分区：
文献类型：
--
作者：
vanBoemmel-Wegmann,Sascha;LoRe3rd,Vincent;Park,Haesuk
尽管直接作用抗病毒药物（DAA）具有高疗效和安全性，但由于DAA药物成本高，HCV治疗的获得经常受到限制。目的：（1）比较HCV单一感染和HCV/HIV合并感染患者在全口服DAA可用之前（前DAA期）和之后（后DAA期）的HCV治疗启动率;（2）估计支付者和患者的HCV治疗费用。研究设计和方法对MarketScan®数据库（2009-2016）中新诊断的HCV患者进行回顾性分析。多变量逻辑回归用于估计在DAA前和DAA后期间开始HCV治疗的比值比（OR）。Kruskal-Wallis检验用于比较双联、三联和全口服治疗的药物成本。结果共纳入HCV感染者15,063例，DAA前合并HIV感染者382例（2.5%），DAA后合并HIV感染者14896429例（2.9%）。HCV/HIV合并感染患者在DAA前阶段接受HCV治疗的几率低于HCV单一感染患者，OR为0.59; 95%置信区间（CI）为0.45-0.78，但在DAA后阶段未观察到HCV治疗接受几率的显著差异（OR为1.08; 95%CI为0.87-1.33）。从2009年到2016年，平均支付者的治疗费用（双重，20，820;全口服DAAs，99，661; p< 0.001）以及平均患者的共同负担费用（双重，593;全口服DAAs 933; p< 0.001）显著增加。结论从DAA前到DAA后，HCV治疗开始率增加，尤其是在HCV/HIV合并感染患者中。然而，支付者每疗程的支出几乎增加了五倍，患者的共同负担增加了55%。
Background Despite the high efficacy and safety associated with direct-acting antivirals (DAAs), access to HCV treatment has been frequently restricted because of the high DAA drug costs. Objectives To (1) compare HCV treatment initiation rates between HCV monoinfected and HCV/HIV coinfected patients before (pre-DAA period) and after (post-DAA period) all-oral DAAs became available; and to (2) estimate the HCV treatment costs for payers and patients. Research Design and Methods A retrospective analysis of the MarketScan® Databases (2009–2016) was conducted for newly diagnosed HCV patients. Multivariable logistic regression was used to estimate the odds ratio (OR) of initiating HCV treatments during the pre-DAA and post-DAA periods. Kruskal–Wallis test was used to compare drug costs for dual, triple and all-oral therapies. Results A total of 15,063 HCV patients 382 (2.5%) HIV coinfected in the pre-DAA period and 14,896 429 (2.9%) HIV coinfected in the post-DAA period were included. HCV/HIV coinfected patients had lower odds of HCV treatment uptake compared to HCV monoinfected patients during the pre-DAA period OR, 0.59; 95% confidence interval (CI), 0.45–0.78, but no significant difference in odds of HCV treatment uptake was observed during the post-DAA period (OR, 1.08; 95% CI, 0.87–1.33). From 2009 to 2016, average payers’ treatment costs (dual, 20,820;all-oralDAAs, 99,661; p< 0.001) as well as average patients’ copayments (dual, 593;all-oralDAAs 933; p< 0.001) increased significantly. Conclusions HCV treatment initiation rates increased, especially among HCV/HIV coinfected patients, from the pre-DAA to the post-DAA period. However, payers’ expenditures per course of therapy saw an almost fivefold increase and patients’ copayments increased by 55%.