title: Hepatitis C treatment completion rates in routine clinical care.
abstract: BACKGROUND
  Treatment completion rates for hepatitis C virus (HCV) infection in clinical practice settings are unknown.
  
  
  METHODS
  We assembled a national cohort of HCV-infected veterans-in-care from 1998 to 2003, using the VA National Patient Care Database for demographical/clinical information, Pharmacy Benefits Management database for pharmacy records and the Decision Support Systems database for laboratory data. We used logistic regression to determine the factors predicting treatment non-completion for HCV.
  
  
  RESULTS
  We identified 134,934 HCV-infected veterans of whom 16,043 [11.9%; 95% confidence interval (CI) 11.7-12.1] were prescribed treatment for HCV. Among the 10,641 veterans with >1 year of follow-up, 2396 (22.5%; 95% CI 21.7-23.3) completed a 48-week course. Non-completers were more likely to have pre-treatment anaemia, coronary artery disease, depression, substance abuse, used standard interferon, higher comorbidity count, and been treated at a low-volume treatment site (defined as sites initiating HCV treatment for <200 individuals). In multivariable analyses, treatment completion was positively associated with pegylated interferon use [odds ratio (OR) 1.59, 95% CI 1.40-1.80] and site treatment volume (OR 1.87, 95% CI 1.56-2.24 for sites initiating treatment for >200 individuals) and negatively associated with pre-treatment anaemia (OR 0.68, 95% CI 0.58-0.80 for haemoglobin 10-14 g/dl) and depression (OR 0.78, 95% CI 0.69-0.89). Human immunodeficiency virus coinfection and minority race were not associated with failing to complete treatment.
  
  
  CONCLUSIONS
  Among veterans-in-care with known HCV, 11.9% initiate therapy of whom 22.5% (one in 56 with known HCV infection) complete a 48-week course of treatment. Higher completion rates among higher volume treatment sites suggest that some factors associated with non-completion (pre-treatment depression and anaemia), may be modifiable with experience.
authors.affiliation: Center for Health Equity Research and Promotion, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA. butta@dom.pitt.edu
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McGinnis
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005006:Ethnicity; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D014728:Veterans; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a