title: Barriers to HCV treatment in the era of triple therapy: a prospective multi-centred study in clinical practice.
abstract: OBJECTIVE
  (i) To describe the demographic, clinical, virological and histological characteristics of the patients undergoing evaluation for indication of triple therapy against hepatitis C virus genotype 1, and to identify the reasons why candidate patients are excluded; and (ii) to evaluate the characteristics of the healthcare environment related to treatment.
  
  
  METHODS
  Observational, prospective and multi-centred study involving 16 hospitals of Spain. Data were collected on 1122 patients receiving attention in the outpatient clinics between June and December 2012.
  
  
  RESULTS
  Of the 1122 patients evaluated, 769 were finally included in this study; 27% (211/769) had contraindications to the therapy. Of those without contraindications, 54% (301/558) did not receive the treatment, and so, only about a third of the patients (33%-257/769) underwent therapy. The reasons for not initiating therapy were as follows: patient refusal (30%), mild disease/awaiting new treatments (34%), restrictions by the health service (30%), other reasons (6%). In univariate analyses, the probability of receiving treatment was related to: age <60 years, male gender, high education level, advanced fibrosis, having had previous treatment, being assessed in a centre of excellence. In multivariate analyses, the factors independently related to the probability of receiving treatment were as follows: high education level of the patients (P = 0.004), advanced fibrosis (P < 0.001) and centres of excellence (P = 0.009).
  
  
  CONCLUSIONS
  Despite the high efficacy of triple therapy, only a small proportion of patients receive the treatment. The causes related to non-treatment depend on patient factors, disease stage and characteristics of the health-service provision.
authors.affiliation: Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla and Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Crespo
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cabezas
authors.forename: Begoña
authors.initials: B
authors.lastname: Sacristán
authors.forename: José L
authors.initials: JL
authors.lastname: Olcoz
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez
authors.forename: Juan
authors.initials: J
authors.lastname: De la Vega
authors.forename: Rosa
authors.initials: R
authors.lastname: García
authors.forename: Félix
authors.initials: F
authors.lastname: García-Pajares
authors.forename: Federico
authors.initials: F
authors.lastname: Sáez-Royuela
authors.forename: José M
authors.initials: JM
authors.lastname: González
authors.forename: Felipe
authors.initials: F
authors.lastname: Jiménez
authors.forename: Santiago
authors.initials: S
authors.lastname: Rodríguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Cuadrado
authors.forename: María J
authors.initials: MJ
authors.lastname: López-Arias
authors.forename: Isidro
authors.initials: I
authors.lastname: García
authors.forename: Ana
authors.initials: A
authors.lastname: Milla
authors.forename: Emilia
authors.initials: E
authors.lastname: García-Riesco
authors.forename: María
authors.initials: M
authors.lastname: Muñoz
authors.forename: Gloria
authors.initials: G
authors.lastname: Sánchez-Antolín
authors.forename: Francisco
authors.initials: F
authors.lastname: Jorquera
mesh_terms: D000367:Age Factors; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D011446:Prospective Studies; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D016312:Treatment Refusal / Q000706:statistics & numerical data
keywords: direct-acting antiviral; hepatitis C virus; limitations; treatment