title: Retrospective analysis of hepatitis C infected patients treated through an integrated care model.
abstract: OBJECTIVE
  To determine if our health system's integrated model reflects sustained virologic response (SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions.
  
  
  METHODS
  Subjects with chronic hepatitis C had their medical records reviewed from November 1st, 2014 through March 1st, 2016. Patients eligible for treatment were entered into an integrated care model therapy algorithm. The primary outcome was SVR12 based on intention to treat (ITT) analysis. Inclusion criteria consisted of both treatment naïve and experienced patients over the age of 18 who were at least twelve weeks post-therapy completion with any genotype (GT) or METAVIR score. Secondary outcomes included adherence, adverse events, and number of drug interaction interventions.
  
  
  RESULTS
  At the time of analysis, 133 patients had reached twelve weeks post therapy with ITT. In the ITT analysis 70 patients were GT 1a, 26 GT 1b, 23 could not be differentiated between GT 1a or 1b, 8 GT 2, 4 GT 3, and 2 patients with multiple genotypes. The ITT treatment regimens consisted of 97 sofosbuvir (SOF)/ledipasvir (LDV), 8 SOF/LDV and ribavirin (RBV), 7 SOF and Simeprevir (SMV), 6 3D and RBV, 1 3D, 11 SOF and RBV, and 1 SOF, peg interferon alpha, and RBV. The overall SVR12 rate was 93% in the ITT analysis with a total of 6 patients relapsing. In patients with cirrhosis, 89% obtained SVR12. All 33 patients who were previous treatment failures achieved SVR12. Drug-drug interactions were identified in 56.4% of our patient population, 69 of which required interventions made by the pharmacist. The most common side effects were fatigue (41.4%), headache (28.6%), nausea (18.1%), and diarrhea (8.3%). No serious adverse effects were reported.
  
  
  CONCLUSIONS
  Dean Health System's integrated care model successfully managed patients being treated for hepatitis C virus (HCV). The integrated care model demonstrates high SVR rates amongst patients with different levels of fibrosis, genotypes, and HCV treatment history.
authors: James M Levin, Shabnam Dabirshahsahebi, Mindy Bauer, Eric Huckins, Department of Infectious Disease, Dean Clinic, Madison, WI 53715, United States.
authors: James M
authors: JM
authors: Levin
authors: James M Levin, Shabnam Dabirshahsahebi, Mindy Bauer, Eric Huckins, Department of Infectious Disease, Dean Clinic, Madison, WI 53715, United States.
authors: Shabnam
authors: S
authors: Dabirshahsahebi
authors: James M Levin, Shabnam Dabirshahsahebi, Mindy Bauer, Eric Huckins, Department of Infectious Disease, Dean Clinic, Madison, WI 53715, United States.
authors: Mindy
authors: M
authors: Bauer
authors: James M Levin, Shabnam Dabirshahsahebi, Mindy Bauer, Eric Huckins, Department of Infectious Disease, Dean Clinic, Madison, WI 53715, United States.
authors: Eric
authors: E
authors: Huckins
mesh_terms: D000368:Aged; D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019033:Delivery of Health Care, Integrated; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008962:Models, Theoretical; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: Direct acting antiviral; Hepatitis C; Integrated care model; Medication adherance; Sustained viral response