title: Treatment patterns and adherence among patients with chronic hepatitis C virus in a US managed care population.
abstract: OBJECTIVE
  The purpose of this study was to document real-world treatment patterns, medication adherence, and the impact of adherence on disease-specific and all-cause health-care costs among chronic hepatitis C virus (HCV) patients in a US managed care population.
  
  
  METHODS
  Commercial insurance claims data between January 1, 2002 and December 31, 2006 from the Ingenix Impact (formerly Integrated Health Care Information Services) database were retrospectively analyzed. Chronic HCV patients with one or more prescriptions for an HCV-specific treatment within 6 months before or at any time after their first observed diagnosis of chronic HCV were selected. Prescribing patterns, treatment cost, and duration of treatment were assessed over the entire therapy period. Medication adherence rates and the relationship between adherence and health-care costs were assessed over the 24-week period after treatment initiation. The results were stratified by key clinical characteristics such as genotype, sustained virologic attainment, and disease severity.
  
  
  RESULTS
  Results showed that peginterferon and ribavirin combination regimens were the most common treatments for chronic HCV. The patients underwent treatment for approximately 30-32 weeks on average, and treatment costs were over $20,000 per patient. Adherence to medication was suboptimal, especially among patients with severe disease. Adherent patients had higher pharmacy costs but significantly lower total costs when pharmacy was excluded.
  
  
  CONCLUSIONS
  New and improved treatments that promote better adherence and impose a lower cost burden on patients and payers are needed.
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC 27709, USA. mitra@rti.org
authors.forename: Debanjali
authors.initials: D
authors.lastname: Mitra
authors.forename: Keith L
authors.initials: KL
authors.lastname: Davis
authors.forename: Cynthia
authors.initials: C
authors.lastname: Beam
authors.forename: Jasmina
authors.initials: J
authors.lastname: Medjedovic
authors.forename: Vinod
authors.initials: V
authors.lastname: Rustgi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008329:Managed Care Programs; D055118:Medication Adherence; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a