(084) Treatment Initiation, Time-to-Treatment, Treatment Duration and Treatment Discontinuation of Direct-Acting Antivirals for Hepatitis-C in Manitoba
Background: Although direct-acting antivirals (DAAs) for Hepatitis C virus (HCV) have proven to be very effective and safe, data on treatment initiation, time-to-treatment, treatment duration and treatment discontinuation of DAAs are limited.
Objectives: This study aimed to evaluate treatment initiation, time-to-treatment, treatment duration and treatment discontinuation of DAAs in Manitoba, Canada.
Methods: A population-based cohort study was conducted using data from the Manitoba Centre for Health Policy Repository housed at University of Manitoba, Canada. Using the test results provided by the Cadham provincial laboratory, individuals in Manitoba with HCV infection were identified. DAA prescriptions from the Drug Program Information Network database were used to identify the study population. Descriptive statistics were used to represent the demographical characteristics as well as main outcomes of the study population. All analyses were conducted using the statistical software package, SAS® 9.4
Results: A total of 1,556 individuals (mean age- 43.1 years, 62.8% males) with HCV filled at least one DAA prescription between 2012 and 2018. A total of 13,771 DAA prescriptions were dispensed during the study period. Treatment initiation increased from 2.0% in 2012 to 56.6% in 2018, with a peak of 77.6% in 2015. Mean time-to-treatment (time from the HCV diagnosis to filling the first DAA prescription) was observed to be 748.5 days (2.1 years). Specialists (98.0%) were the most common prescribers followed by general practitioners (2.0%) to prescribe DAAs in Manitoba. Most common treatment duration was of 12-weeks (36.2%), followed by 48-weeks and 16-weeks (33.8% and 16.4%), respectively. Treatment discontinuation (i.e., < 8-weeks) was observed in 40 patients (2.6%).
Conclusions: The current DAA treatment initiation and time-to-treatment rates remain suboptimal. However, data confirm low rates of treatment discontinuation with DAAs. Future research focusing on associations between demographic and socio-economic characteristics with treatment initiation and discontinuation may help further optimize care for patients with HCV and to maximize the public health impact of DAAs.
