Interventions To Improve Patient Adherence to Hepatitis C Treatment: Comparative Effectiveness

Research Review - Final – Dec. 20, 2012 

Interventions To Improve Patient Adherence to Hepatitis C Treatment: Comparative Effectiveness

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Contents
Executive Summary .....................................ES-1
Introduction ........................................................1
Condition Definition .......................................... 1
Prevalence and Disease Burden .......................... 1
Etiology and Natural History of Hepatitis C Infection ............ 1
Hepatitis C Virus Genotypes and Detection ................. 2
Treatment of Chronic Hepatitis C Infection ..............2
Adherence in the Context of Chronic Hepatitis C Treatment .......... 4
Risk Factors for Nonadherence to Antiviral Treatment .............. 5
Association of Adherence With Sustained Viral Response .............. 6
Interventions for Improving Adherence ................. 7
Scope and Purpose .............. 7
Key Questions ...................... 8
Methods..................................9
Topic Development and Refinement ........................ 9
Analytic Framework ................. 9
Literature Search Strategy .................... 10
Process for Study Selection ................... 10
Data Abstraction and Data Management ................ 12
Individual Study Quality Assessment ...................... 12
Data Synthesis ............................. 13
Grading the Strength of Evidence .................. 13
Applicability ...................... 14
Review Process .................. 14
Results..................................15
Literature Search ................. 15
Characteristics of Included Studies ............. 16
Results of Included Studies .......................... 30

Key Question 1 (Intermediate and Final Health Outcomes) and Key Question 2
(Treatment Adherence) .......................... 30
System-Level Interventions Versus Usual Care .......................30
Regimen-Related Interventions Versus Usual Care ..................33
Patient-Level Interventions Versus Usual Care ........................34
Adverse Event Management Interventions Versus Usual Care/Placebo .........37

Does the Comparative Effectiveness of Treatment Adherence Interventions Differ
by Patient Subgroups?.........................40
Key Question 3. Harms ...................... 40
Summary and Discussion .....................47
Overview of Main Findings ................. 47
Outcomes of Adherence Interventions .................. 48
Strength of Evidence .............................. 48
Health Outcomes ..................................... 48
Intermediate Outcomes ............................ 49
Findings in Relationship to What Is Already Known .................... 53
Applicability of the Evidence to the United States Health Care System ....... 53
Limitations ............................ 54
Potential Limitations of Our Approach................54
Limitations of the Literature ................................55
Implications for Clinical and Policy Decisionmaking............... 56
Evidence Gaps................................... 57
Future Research ................................ 57