title: Huge gap between clinical efficacy and community effectiveness in the treatment of chronic hepatitis C: a nationwide survey in Taiwan.
abstract: Peginterferon/ribavirin provides a substantially high treatment efficacy for chronic hepatitis C virus (HCV) infections in Asians. Whether the clinical efficacy can be translated to community effectiveness remains unclear. The disease awareness, treatment accessibility, recommendations, acceptance, and barriers to anti-HCV treatment were explored to clarify the issue with a 3-step nationwide investigation in Taiwan. A crude HCV-infected population was estimated using databases from 3 large-scale surveillance studies and age-/geographic-specific population database. HCV awareness and accessibility were investigated at the patient level in 58,129 residents. The recommendations/acceptances and barriers to treatment at the provider level were evaluated using a prospective, nationwide approach to 89 gastroenterologists/hepatologists. The estimated 10-year interval age-adjusted anti-HCV-seropositive population is 745,109 (3.28%), with an anticipated HCV-viremic population of 554,361. Of anti-HCV-seropositive subjects, 36.2% had disease awareness. Among those with awareness, 39.6% had accessibility. The recommendation/acceptance rate of antiviral therapy was 70.6%. The treatment rate was 10.1% and 13.7% for the anti-HCV-seropositive and HCV-viremic population, respectively. With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment. The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%). Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan. Increasing disease awareness/treatment accessibility and introducing new therapeutic strategies with high tolerability are warranted.
authors.affiliation: From the Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital (Ming-Lung Yu, Ming-Lun Yeh, P-CT, J-FH, C-FH, P-CL, Y-HL, M-YH, Z-YL, S-CC, C-YD, W-LC, W-YC); Faculty of Internal Medicine, College of Medicine, and Graduate Institute of Clinical Medicine, and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University (Ming-Lung Yu, J-FH, C-FH, M-HH, Z-YL, S-CC, C-YD, W-LC); Institute of Biomedical Sciences, National Sun Yat-Sen University (Ming-Lung Yu); Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (C-IH, N-JH); Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital (C-FH); Department of Preventive Medicine, Kaohsiung Medical University Hospital (M-HH); Department of Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-YL); and Taiwan Liver Research Foundation, Kaohsiung, Taiwan (W-YC).
authors.forename: Ming-Lung
authors.initials: ML
authors.lastname: Yu
authors.forename: Ming-Lun
authors.initials: ML
authors.lastname: Yeh
authors.forename: Pei-Chien
authors.initials: PC
authors.lastname: Tsai
authors.forename: Ching-I
authors.initials: CI
authors.lastname: Huang
authors.forename: Jee-Fu
authors.initials: JF
authors.lastname: Huang
authors.forename: Chung-Feng
authors.initials: CF
authors.lastname: Huang
authors.forename: Meng-Hsuan
authors.initials: MH
authors.lastname: Hsieh
authors.forename: Po-Cheng
authors.initials: PC
authors.lastname: Liang
authors.forename: Yi-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Hsieh
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Lin
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Hou
authors.forename: Zu-Yau
authors.initials: ZY
authors.lastname: Lin
authors.forename: Shinn-Cherng
authors.initials: SC
authors.lastname: Chen
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Dai
authors.forename: Wan-Long
authors.initials: WL
authors.lastname: Chuang
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015995:Prevalence; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b
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