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Treatment patterns, health care resource utilization, and costs in U.S. patients diagnosed with chronic hepatitis C infection who received telaprevir or boceprevir.

Publication ,  Journal Article
Le, TK; Kalsekar, A; Macaulay, D; Yuan, Y; Sorg, RA; Behrer, CR; Wei, J; Wu, EQ
Published in: Journal of managed care & specialty pharmacy
April 2015

Chronic hepatitis C (CHC) is associated with substantial morbidity and mortality, with the future burden of disease predicted to significantly increase. The recent addition of 2 direct-acting antiviral (DAA) protease inhibitors, telaprevir and boceprevir, to peginterferon alfa (PEG) and ribavirin (RBV) therapy has been shown to significantly improve sustained virologic response rates and thus has become standard of care. While the efficacy and safety of DAAs has been assessed in the clinical trial setting, less is known about real-world use of these new therapies.To (a) evaluate the treatment patterns, health care utilization, and costs of CHC patients receiving DAA-based therapies in the United States using a retrospective analysis of a large administrative claims database and (b) evaluate factors associated with therapy noncompletion using multivariable analyses.Adult patients with ≥ 1 claim for CHC and a prescription filled for boceprevir or telaprevir were selected from a de-identified U.S.-based claims database. The date of the first fill for a DAA after May 13, 2011 (date of first DAA availability) was defined as the index date, and patients were categorized into either the telaprevir or boceprevir cohort. Patients were required to have continuous eligibility and no claims for hepatitis B during the 6 months before (baseline) and 12 months following (study period) the index date. Baseline characteristics and study period treatment patterns, health care utilization, and costs were described. Factors associated with therapy noncompletion were examined using multivariable logistic regression, and adjusted health care costs were compared between the DAA cohorts using multivariable analyses.A total of 871 telaprevir and 284 boceprevir patients were identified. DAA patients were aged 54 years on average and more often were male (60%, n = 688). Approximately 25% (n = 216) of telaprevir and 18% (n = 52) of boceprevir patients had cirrhosis, and 9% (n = 82) of telaprevir and 7% (n = 20) of boceprevir patients had decompensated cirrhosis at baseline. Less than 1% (n = 9) of patients were HIV co-infected. Approximately 54% (n = 470) of telaprevir and 74% (n = 210) of boceprevir patients did not complete the minimum duration of therapy as per the prescribing information (telaprevir: 12 weeks of triple + 12 weeks of dual; boceprevir: 3 weeks of lead-in + 24 weeks of triple). In multivariable analyses, females (vs. males) and patients taking boceprevir (vs. telaprevir) were more likely to not complete therapy (P = 0.011). CHC patients experienced high medical and drug-related resource utilization. Telaprevir patients had numerically higher study period unadjusted medical (boceprevir: $16,927; telaprevir: $19,519) and drug costs (boceprevir: $59,953; telaprevir: $76,497) than boceprevir patients; however, after adjusting for baseline characteristics, only drug costs remained significantly different (P  less than  0.001). These results indicate that a large proportion of CHC patients receiving telaprevir or boceprevir did not complete minimum duration of therapy as per the prescribing information. CHC patients on a DAA regimen also experienced high resource utilization and high medical and drug costs.

Duke Scholars

Published In

Journal of managed care & specialty pharmacy

DOI

EISSN

2376-1032

ISSN

2376-0540

Publication Date

April 2015

Volume

21

Issue

4

Start / End Page

308 / 318

Related Subject Headings

  • United States
  • Retrospective Studies
  • Proline
  • Practice Patterns, Physicians'
  • Oligopeptides
  • Middle Aged
  • Male
  • Humans
  • Hepatitis C, Chronic
  • Health Resources
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Le, T. K., Kalsekar, A., Macaulay, D., Yuan, Y., Sorg, R. A., Behrer, C. R., … Wu, E. Q. (2015). Treatment patterns, health care resource utilization, and costs in U.S. patients diagnosed with chronic hepatitis C infection who received telaprevir or boceprevir. Journal of Managed Care & Specialty Pharmacy, 21(4), 308–318. https://doi.org/10.18553/jmcp.2015.21.4.308
Le, T Kim, Anupama Kalsekar, Dendy Macaulay, Yong Yuan, Rachael A. Sorg, Christopher R. Behrer, Jin Wei, and Eric Q. Wu. “Treatment patterns, health care resource utilization, and costs in U.S. patients diagnosed with chronic hepatitis C infection who received telaprevir or boceprevir.Journal of Managed Care & Specialty Pharmacy 21, no. 4 (April 2015): 308–18. https://doi.org/10.18553/jmcp.2015.21.4.308.
Le TK, Kalsekar A, Macaulay D, Yuan Y, Sorg RA, Behrer CR, et al. Treatment patterns, health care resource utilization, and costs in U.S. patients diagnosed with chronic hepatitis C infection who received telaprevir or boceprevir. Journal of managed care & specialty pharmacy. 2015 Apr;21(4):308–18.
Le, T. Kim, et al. “Treatment patterns, health care resource utilization, and costs in U.S. patients diagnosed with chronic hepatitis C infection who received telaprevir or boceprevir.Journal of Managed Care & Specialty Pharmacy, vol. 21, no. 4, Apr. 2015, pp. 308–18. Epmc, doi:10.18553/jmcp.2015.21.4.308.
Le TK, Kalsekar A, Macaulay D, Yuan Y, Sorg RA, Behrer CR, Wei J, Wu EQ. Treatment patterns, health care resource utilization, and costs in U.S. patients diagnosed with chronic hepatitis C infection who received telaprevir or boceprevir. Journal of managed care & specialty pharmacy. 2015 Apr;21(4):308–318.

Published In

Journal of managed care & specialty pharmacy

DOI

EISSN

2376-1032

ISSN

2376-0540

Publication Date

April 2015

Volume

21

Issue

4

Start / End Page

308 / 318

Related Subject Headings

  • United States
  • Retrospective Studies
  • Proline
  • Practice Patterns, Physicians'
  • Oligopeptides
  • Middle Aged
  • Male
  • Humans
  • Hepatitis C, Chronic
  • Health Resources