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Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis

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  • Philip Vutien
  • Michelle Jin
  • Michael H Le
  • Pauline Nguyen
  • Sam Trinh
  • Jee-Fu Huang
  • Ming-Lung Yu
  • Wan-Long Chuang
  • Mindie H Nguyen

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.

Suggested Citation

  • Philip Vutien & Michelle Jin & Michael H Le & Pauline Nguyen & Sam Trinh & Jee-Fu Huang & Ming-Lung Yu & Wan-Long Chuang & Mindie H Nguyen, 2017. "Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-17, September.
    • Handle: RePEc:plo:pone00:0183851
    DOI: 10.1371/journal.pone.0183851
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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