Abstract
Background & aimsTreatment 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.MethodsWe 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.ResultsWe 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.ConclusionsOnly 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.
Highlights
Together with chronic hepatitis B, chronic hepatitis C (CHC) is a leading cause of death and disability worldwide.[1]
We conducted a manual search of abstracts using the term ‘hepatitis C’ from annual international scientific meetings held in the 2 years preceding the literature search date and by the American Association for the Study of Liver Diseases (AASLD), Digestive Disease Week, the Asian Pacific Study of the Liver, and the European Association for the Study of the Liver (EASL)
We found that only one-quarter (25.5%) of CHC patients received antiviral therapy
Summary
Together with chronic hepatitis B, chronic hepatitis C (CHC) is a leading cause of death and disability worldwide.[1]. As part of a global strategy for eliminating viral hepatitis as a major public health concern by 2030, the World Health Organization (WHO) has set a goal of treating 80% of eligible CHC with antiviral therapy.[2] treatment rates are far below this number. Several U.S based studies report treatment rates with pegylated-interferon (PEG-IFN) and ribavirin (RBV) that range from nine to 36%.[3,4,5,6,7] In their report the WHO estimates that under 1% of treatment eligible CHC patients worldwide have received antiviral therapy.[2]
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