Practice Patterns and Treatment Outcomes in the Management of Chronic Hepatitis C (CHC) Infection in a Large Managed Care Cohort

Abstract

Purpose: Chronic hepatitis C (CHC) infection remains a leading cause of chronic liver disease, and is of significant concern to insurers and health planners. Although the efficacy of antiviral therapy for CHC is well documented in controlled research populations, its effectiveness in community practice remains less clearly defined. Assessment of practice patterns and treatment outcomes in a large community cohort may inform policy-making among third-party payers. Methods: We reviewed the administrative, laboratory, and pharmacy databases of selected sites within the Kaiser Permanente Northern California Health System, a large health maintenance organization with 3.1 million members. We identified subjects with CHC infection using ICD-9 diagnoses (070.54) and anti-HCV antibody records. Administrative files were used to obtain demographic information on age, gender, and ethnicity. Laboratory records were used to obtain data on HCV RNA, HCV genotype, AST, ALT, CBC. Pharmacy records were used to obtain data on use of interferon (IFN)/ribavirin (RBV), pegylated interferon (PEG-IFN)/ribavirin (RBV), procrit, neupogen, antidepressants, and transfusions. Results: We identified 1470 patients with a documented ICD-9 diagnosis of CHC infection between 1999–2004. Of these patients, 246 underwent treatment with either IFN/RBV (n = 119) or PEG-IFN/RBV (n = 123). The mean age was 47.1 years (95% CI 33.3–60.91), and 158/242 (65.3%) were male. The average duration of therapy was 29.2 weeks. The overall rate of sustained virologic response (SVR) was 48/242 (19.8%), including 14/119 (11.8%) for IFN/RBV and 34/123 (27.6%) for PEG-IFN/RBV. Conclusions: Many patients with CHC infection in a large community cohort do not undergo antiviral therapy. The rate of SVR following antiviral therapy is significantly lower than what is observed in controlled trial settings. Further research is needed to identify the key barriers to treatment and therapeutic success in these patients