Effect of a Liver Psychology Team on Mental Health Related Treatment Discontinuation Rates

Abstract

Purpose: Hepatitis C (HCV) has a higher prevalence in veterans. Despite availability of effective therapies, unacceptably high therapy (tx) discontinuation rates remain a significant barrier to successful outcomes with combination tx. Veterans have increased mental health co-morbidities and decreased rate of tx candidacy, as well as premature discontinuation of HCV tx secondary to mental health side-effects. The overall discontinuation rates in registration trials were reported to be 13–15%. Mental health related discontinuation rates as high as 15% have been reported with IFN based treatments. The effect of a liver psychology team on treatment discontinuation rates is not well established. Methods: A database was created to evaluate the interaction of hepatitis C and diabetes. Out of this database 148 patients were identified to have received tx for hepatitis C between 1999 and 2006. We evaluated the mental health tx discontinuation rates in this very diverse group of patients, including post-transplant, pre-transplant, re-treatment and tx naïve patients. Results: From 1999–2006 148 patients were identified in the database that were treated with interferon based therapies. Mean age was 53.0 ± 0.5. 98% were male. 64 patients (43%) completed therapy. 52 (35.1%) were discontinued for non-response. 32 (21.6%) were discontinued prematurely secondary to side-effects. Of the 32 patients, who discontinued tx for side effects, 7 (21.9%) had mental health reasons. Overall 4.3% of the patients were discontinued for mental health reasons. 17.9% of patients seen by liver psychology had MH discontinuations as opposed to 50% of the patients not seen by liver psychology. 7 out of 96 patients treated prior to 2003 as opposed to 0 out of 45 patients treated after 2003 had treatment discontinuation for MH reasons. Conclusion: Mental health co-morbidities leading to decreased therapy candidacy and treatment discontinuations represent a significant barrier to therapy. An integrated liver psychology team can have a significant impact on therapy discontinuation rates.