Abstract
BackgroundApproximately 3.5 million Americans are infected with the hepatitis C virus (HCV). Although many patients with HCV are asymptomatic, HCV is the leading cause of infection-related death in the U.S. With advances in curative medication therapy for HCV, many of these deaths are preventable. Access to innovative therapies may be unevenly distributed. Our objective was to describe medication prescribers’ adoption of innovative HCV pharmacotherapy across prescriber, geographical location, and time.MethodsThis is a retrospective, secondary data analysis among a national cohort of patients prescribed direct-acting antiviral HCV medications with curative intent. We assessed prescriptions by time, geographic location, and provider type.ResultsThe peak of the adoption rate occurred within 45 days; nearly one-sixth of all prescribers had already prescribed one of the new drugs. Geographical regions (Midwest, South, and West all p ≥ 0.05) nor gender (p = 0.455) of a prescriber impacted adoption. Similarly, patient income did not influence the likelihood of a prescriber to adopt the new drugs earlier (p = 0.175). Gastroenterologists or hepatologists were more likely earlier adopters compared to primary care physicians (p = 0.01).ConclusionsBecause of the relative advantage of newer therapies, we anticipated that there would be an initial surge as early adopters prescribed the new medications and use would dwindle over time as the initial HCV cohort was cured. The data demonstrate that our hypothesis is essentially supported. There is a reduction in prescriptions at approximately 5 months post-approval and treatment is typically required for 3 months. There has been a surge in clinicians’ adoption of innovative HCV treatments. As patients are cured of their infection, we anticipate a decreased need for chronic management of HCV.Trial registrationNot applicable.KeywordsDissemination researchHealth services researchInfectious diseaseHepatitis C
Highlights
3.5 million Americans are infected with the hepatitis C virus (HCV)
After limiting our analysis to prescribers with valid information associated with their National Provider Index (NPI) regarding their sex and zip code information, and who had written a prescription to an adult aged 18 years or older for one of the drugs of interest during the study time period, there were 6712 unique prescribers in the analytic cohort
The results indicated a wide variation in the first Rx day by the respective NPIs, ranging from 2 to 548
Summary
3.5 million Americans are infected with the hepatitis C virus (HCV). many patients with HCV are asymptomatic, HCV is the leading cause of infection-related death in the U.S With advances in curative medication therapy for HCV, many of these deaths are preventable. In 2011, two direct-acting antivirals were approved by the FDA, boceprevir and telaprevir, for the treatment of patient with genotype 1 HCV Adoption of these medications was limited by the need to use them in combination with existing, poorly tolerated therapies. Several other medications entered the market in 2013 including the first once daily protease inhibitor, simeprevir, and the first polymerase inhibitor, sofosbuvir While these two medications were used together off-label to treat genotype 1 infection without interferon, it was not until October 2014 when the FDA approved the first all-oral single combination pill treat genotype 1 HCV, ledipasvir/sofosbuvir. In December 2014, another interferon-free regimen, ombitasvir/paritaprevir/ritonavir, was approved; ombitasvir/paritaprevir/ritonavir trials demonstrated high cure rate for patients with genotype 1 HCV [14] In addition to their improvement in cure rate, direct-acting antivirals were better tolerated than interferon by patients because of the significantly reduced side effects and shorter duration of treatment
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