Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis

<div><p>Background & aims</p><p>Treatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C.</p><p>Methods</p><p>We conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity.</p><p>Results</p><p>We included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1–30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (<i>p</i> = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, <i>p</i> = 0.04), region (Europe vs. North America <i>p</i> = 0.004), and data source (clinical chart review vs. administrative database, <i>p</i> = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care.</p><p>Conclusions</p><p>Only one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.</p></div

Characteristics of included studies.

<p>Characteristics of included studies.</p

Overall pooled treatment rate for all patients with chronic hepatitis C.

<p>Overall pooled treatment rate for all patients with chronic hepatitis C.</p

Pooled treatment rates for patients with chronic hepatitis C, by region.

<p>Pooled treatment rates for patients with chronic hepatitis C, by region.</p

Pooled treatment ineligibility rates for patients with chronic hepatitis C, by reasons for ineligibility.

<p>Pooled treatment ineligibility rates for patients with chronic hepatitis C, by reasons for ineligibility.</p

Meta-regression for predictors for antiviral therapy for chronic hepatitis C.

<p>Meta-regression for predictors for antiviral therapy for chronic hepatitis C.</p

Pooled patient refusal rates in treatment-eligible patients with chronic hepatitis C, by reasons for refusal.

<p>Pooled patient refusal rates in treatment-eligible patients with chronic hepatitis C, by reasons for refusal.</p

Pooled treatment eligibility rates for patients with chronic hepatitis C, by region.

<p>Pooled treatment eligibility rates for patients with chronic hepatitis C, by region.</p

PRISMA flow diagram.

<p>PRISMA flow diagram.</p