Is the management of hepatitis C patients appropriate? A population-based study.
BACKGROUND
In order for hepatitis C patients to receive antiviral treatment, they must reach medical care.


OBJECTIVE
To assess the proportion of patients reaching medical care after hepatitis C diagnosis in a general population (1 006 171 inhabitants) in France.


METHODS
Between 1994 and 1999, 1508 cases were diagnosed, of which 1251 were eligible for the study.


RESULTS
Two-hundred and two patients did not have any medical care; among them, 55.4% had normal alanine transferase, 58.4% had risk factors related to lifestyle and 22.8% were alcoholics. Amongst the 1049 other patients, 41.6% had a liver biopsy, 25.0% were treated. Treatment was more often carried out in males than in females (OR: 1.59; P = 0.001), and in patients under 65 than in older patients (OR: 2.22; P < 0.008). Among non-treatment reasons, alcoholism (P = 0.001), drug-addiction (P = 0.04) and escaping monitoring (P = 0.04) were more frequent in males than in females, whereas normal alanine transferase was more frequent in females than in males (P = 0.004). Amongst 278 patients with a Metavir score >A1F1, 71 (25.5%) did not undergo treatment.


CONCLUSIONS
In a general population, one patient in six did not receive on-going health care; a quarter of patients with a Metavir score >A1F1 did not receive any treatment. These results showed insufficient clinical management, which could compromise the effectiveness of treatment in general population.
Hatem
C
C
Réseau Bourguignon de lutte contre l'hépatite C, Faculté de médecine de Dijon, Boulevard Jeanne d'Arc, 21034 Dijon Cedex, France.
Minello
A
A
Bresson-Hadni
S
S
Jooste
V
V
Evrard
P
P
Obert
B
B
Lepage
C
C
Bonithon-Kopp
C
C
Faivre
J
J
Monnet
E
E
Miguet
J-P
JP
Hillon
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000592:standards; D042241:Early Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012423:Rural Health; D012720:Severity of Illness Index; D013997:Time Factors; D014504:Urban Health
D000998:Antiviral Agents