Predictors of hepatitis C virus treatment in Veterans

Predictors of hepatitis C virus treatment in Veterans

A study in the latest issue of the American Journal of Gastroenterology reports on the importance of patient, provider, and facility predictors of hepatitis C virus treatment in veterans.

Several patient characteristics are known to impact hepatitis C virus antiviral treatment rates.
However, it is unclear whether, and to what extent, health-care providers or facility characteristics impact hepatitis C virus treatment rates.

Using national data obtained from the Department of Veterans Affairs (VA) hepatitis C virus Clinical Case Registry, Dr Jennifer Kramer and colleagues from Texas, USA conducted a retrospective cohort study of patients with active hepatitis C virus viremia, who were diagnosed between 2003 and 2004.

The research team evaluated patient-, provider-, and facility-level predictors of receipt of hepatitis C virus treatment with hierarchical logistic regression.
Patients with high hemoglobin levels were more likely to receive treatment

The overall hepatitis C virus treatment rate in 29,695 patients was 14%.
The strongest independent predictor for receipt of treatment was consultation with an hepatitis C virus specialist.

The research team found that patients were less likely to receive hepatitis C virus treatment if they were Black, older, male, current users of alcohol or drugs, had hepatitis C virus genotype 1 or 4, had higher creatinine levels, or had severe anxiety/post-traumatic stress disorder or depression.

Patients with high hemoglobin levels, cirrhosis, and persistently high liver enzyme levels were more likely to receive treatment.
Patient, provider, and facility factors explained 15, 4, and 4%, respectively, of the variation in treatment rates.

Treatment rates for hepatitis C virus are low in the VA.
In addition to several important patient-level characteristics, the researchers found that a specialist consultant has a vital role in determining whether a patient should receive hepatitis C virus treatment.

Dr Kramer's team concludes, "These findings support the development of patient-level interventions targeted at identifying and managing comorbidities, and contraindications and fostering greater involvement of specialists in the care of hepatitis C virus."

Am J Gastroenterol 2011; 106: 483–9121 March 2011