title: Impact of provider type on hepatitis C outcomes with boceprevir-based and telaprevir-based regimens.
abstract: OBJECTIVE
  To examine the effect of provider type on outcomes and safety in a large hepatitis C virus (HCV)-infected cohort treated in routine medical practice.
  
  
  BACKGROUND
  Nonphysician providers (NPP) are uniquely positioned to expand health care infrastructure to meet HCV treatment demands.
  
  
  METHODS
  Retrospective, observational cohort analysis of 820 HCV genotype 1-infected veterans initiated on peginterferon/ribavirin and boceprevir or telaprevir in routine medical practice at 94 VA facilities before January 1, 2012 and followed through July 30, 2013. Provider type was determined from prescription records and included physicians (MD) or NPPs (ie, nurse practitioners, physician assistants, and pharmacists). Inverse probability-of-treatment weighting and unweighted logistic regression analysis was used for comparison of sustained virologic response (SVR), treatment discontinuation rates, and adverse hematologic events.
  
  
  RESULTS
  There was no significant difference in SVR by provider type overall (NPPs 52% vs. MDs 49%, P=0.33) and within patient subgroups, or in treatment discontinuation rates. In multivariate analyses, provider type was not associated with any significant difference in the odds of achieving SVR (NPP vs. MD; odds ratio 1.17; 95% confidence interval, 0.84-1.63; P=0.37 inverse probability of treatment weighting; odds ration 1.16, 95% confidence interval, 0.84-1.59, P=0.38 unweighted). Hematologic adverse event rates were similar: anemia: 57% NPP, 62% MD; thrombocytopenia: 43% NPP, 40% MD; neutropenia: 40% NPP, 39% MD.
  
  
  CONCLUSIONS
  Treatment prescribed by NPPs was as likely to result in SVR as treatment prescribed by MDs, even after accounting for patient differences. Engaging more NPPs as HCV treatment providers may allow wider access to HCV treatment.
authors.affiliation: *Office of Public Health/Population Health †Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Backus
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Belperio
authors.forename: Troy A
authors.initials: TA
authors.lastname: Shahoumian
authors.forename: Larry A
authors.initials: LA
authors.lastname: Mole
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005838:Genotype; D006282:Health Personnel / Q000706:statistics & numerical data*; D006402:Hematologic Diseases / Q000453:epidemiology / Q000209:etiology; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage* / Q000009:adverse effects; D011392:Proline / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data; D019562:Viral Load / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline