A multidisciplinary support programme increases the efficiency of pegylated interferon alfa-2a and ribavirin in hepatitis C

Background & Aims: Adherence to antiviral treatment is important to achieve sustained virological response (SVR) in chronic hepatitis C (CHC). We evaluated the efficiency of a multidisciplinary support programme (MSP), based on published HIV treatment experience, to increase patient adherence and the efficacy of pegylated interferon alfa-2a and ribavirin in CHC. Methods: 447 patients receiving antiviral treatment were distributed into 3 groups: control group (2003-2004, n = 147), MSP group (2005-2006, n = 131), and MSP-validation group (2007-2009, n = 169). The MSP group included two hepatologists, two nurses, one pharmacist, one psychologist, one administrative assistant, and one psychiatrist. Cost-effectiveness analysis was performed using a Markov model. Results: Adherence and SVR rates were higher in the MSP (94.6% and 77.1%) and MSP-validation (91.7% and 74.6%) groups compared to controls (78.9% and 61.9%) (p < 0.05 in all cases). SVR was higher in genotypes 1 or 4 followed by the MSP group vs. controls (67.7% vs. 48.9%, p = 0.02) compared with genotypes 2 or 3 (87.7% vs. 81.4%, p = n.s.). The MSP was the main predictive factor of SVR in patients with genotype 1. The rate of adherence in patients with psychiatric disorders was higher in the MSP groups (n = 95, 90.5%) compared to controls (n = 28, 75.7%) (p = 0.02). The cost per patient was (sic) 13,319 in the MSP group and (sic) 16,184 in the control group. The MSP group achieved more quality-adjusted life years (QALYs) (16.317 QALYs) than controls (15.814 QALYs) and was dominant in all genotypes. Conclusions: MSP improves patient compliance and increases the efficiency of antiviral treatment in CHC, being cost-effective. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.