Real‐world experience for the outcomes and costs of treating hepatitis C patients: Results from the German Hepatitis C-Registry (DHC-R)

Abstract

Background & Aims With long-term consequences like the development of liver cirrhosis and hepatocellular carcinoma, chronic hepatitis C virus (HCV) infection is associated with a significant health burden. Information on HCV treatment outcomes and costs in routine care is still rare, especially for subgroups. The aim of this study was to analyse the treatment outcomes and costs of subgroups in routine care and to compare them over time with previous analyses.

Methods Data were derived from a noninterventional study including a subset of 10298 patients receiving DAAs with genotypes 1 and 3. Sociodemographic, clinical parameters and costs were collected using a web-based data recording system. The total sample was subdivided according to treatment regimen, cirrhosis status as well as present HIV infection and opioid substitution treatment (OST).

Results 95% of all patients achieved SVR. Currently used DAA showed higher SVR-rates and less adverse events (AE) compared to former treatments. Concerning subgroups, cirrhotic patients, HIV-coinfected patients and OST patients showed lower but still high SVR-rates. In comparison, cirrhotic had considerably longer treatment duration and more frequent (serious) AE. Overall, average treatment costs were €48470 and costs per SVR were €51129; for currently used DAAs costs amounted to €30330 and costs per SVR to €31692. After the end of treatment, physical health is similar to the general population in all patients except cirrhotic. Mental health remains far behind in all subgroups, even for currently used DAA.

Conclusions Over time, some relevant factors developed positively (SVR-rates, costs, treatment duration, adverse events, health-related quality of life (HRQoL)). Further research on HRQoL, especially on mental health, is necessary to evaluate the differences between subgroups and HRQoL over time and to identify influencing factors.

Zusammenfassung

Hintergrund und Ziele Die chronische Infektion mit dem Hepatitis-C-Virus (HCV) ist mit Langzeitfolgen wie der Entwicklung einer Leberzirrhose oder eines hepatozellulären Karzinoms assoziiert und stellt eine erhebliche Gesundheitsbelastung dar. Informationen über HCV-Behandlungsergebnisse und -kosten in der Praxis sind nach wie vor rar, insbesondere für Subgruppen. Ziel dieser Studie war es, die Behandlungsergebnisse und -kosten von Subgruppen in der Versorgung zu analysieren und sie mit früheren Analysen zu vergleichen.

Methoden Die Daten stammen aus einer nicht interventionellen Studie mit einer Untergruppe von 10298 Patient*innen, die DAA erhalten und die Genotypen 1 und 3 aufweisen. Soziodemografische und klinische Parameter sowie Kosten wurden mithilfe eines webbasierten Datenerfassungssystems erhoben. Für die Analysen wurden verschiedene Subgruppen definiert: Die Gesamtstichprobe wurde nach Zirrhosestatus und nach vorhandener HIV-Infektion und Opioidsubstitutionsbehandlung (OST) unterteilt.

Ergebnisse 95 % aller Patienten erreichten eine SVR. Die derzeit verwendeten DAA wiesen im Vergleich zu früheren Behandlungen höhere SVR-Raten und weniger unerwünschte Ereignisse (AE) auf. Was die Untergruppen betrifft, so wiesen zirrhotische Patienten, HIV-Koinfizierte und OST-Patienten niedrigere, aber immer noch hohe SVR-Raten auf. Im Vergleich dazu hatten Zirrhotiker eine deutlich längere Behandlungsdauer und häufiger (schwere) Nebenwirkungen. Insgesamt beliefen sich die durchschnittlichen Behandlungskosten auf 48470 € und die Kosten pro SVR auf 51129 €; für die derzeit verwendeten DAAs beliefen sich die Kosten auf 30330 € und die Kosten pro SVR auf 31692 €. Nach Abschluss der Behandlung ist der körperliche Gesundheitszustand bei allen Patienten mit Ausnahme der Zirrhotiker mit dem der Allgemeinbevölkerung vergleichbar. Die psychische Gesundheit bleibt in allen Untergruppen weit zurück, selbst bei derzeit verwendeten DAA.

Schlussfolgerungen Im Laufe der Zeit entwickelten sich einige relevante Faktoren positiv (SVR-Raten, Kosten, Behandlungsdauer, unerwünschte Ereignisse, gesundheitsbezogene Lebensqualität [HRQoL]). Weitere Forschung zur HRQoL, insbesondere zur psychischen Gesundheit, ist erforderlich, um die Unterschiede zwischen den Subgruppen und die HRQoL im Zeitverlauf zu bewerten und Einflussfaktoren zu identifizieren.

Schlüsselwörter

Leber - Virushepatitis - Hepatitis C - Klinische Praxis - Registerdaten - SVR - Lebensqualität - HIV - Drogenkonsumenten - Kosten

Keywords

liver - viral hepatitis - hepatitis C - clinical practice - registry data - SVR - quality of life - HIV - drug users - costs

Publication History

Received: 29 October 2021

Accepted after revision: 15 April 2022

Article published online:
15 July 2022

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