What Matters Most for Treatment Decisions in Hepatitis C: Effectiveness, Costs, and Altruism
- 95 Downloads
Comparative evaluations of innovations in hepatitis C virus (HCV) drug therapy typically focus on sustained virologic response (SVR) without addressing psychological and socioeconomic challenges that extend beyond virologic cure. This study aims to identify and prioritize variables important to patients when making the decision to start HCV treatment.
A three-round Delphi process was conducted with the first round derived from a systematic literature review and advisory board input, including patients who have been affected by HCV, physicians, pharmacists, and a patient group representative. Delphi panelists were HCV patients who had received treatment or were considering treatment. Panelists were asked about factors influencing their HCV treatment decisions. Thematic analysis of open-ended responses based on grounded theory was used. Agreement with each category and rankings based on order of importance from the patient perspective was reported.
Treatment effectiveness (100% agreement), longer life (88%), fear of complications (84%), financial issues (80%), quality of life (100%), and impact on society (80%) were considered important factors to patients in decisions to seek treatment. A fear of harming others (87%) was considered more important than physical symptoms (83%) in terms of patient-reported problems caused by HCV. Medication costs (91%) were identified as the most important costs of having HCV, followed by doctor costs (77%).
In addition to treatment effectiveness, patient experiences with financial problems, quality of life, and altruistic desires impact HCV patients’ decisions. The risk of infecting others may motivate patients to seek treatment as much as personally experienced physical symptoms.
The authors would like to thank the patient-centered advisory board members for their contribution to the concept, design, and interpretation of this study.
Study concept and design: all; drafting of manuscript: TJM; critical reviews: all; statistical analysis: TJM; interpretation of data: all; final version approval: all.
The Stakeholder Advisory Board described in this manuscript was initiated with a research grant from the Patient Centered Outcomes Research Institute.
Compliance with ethical standards
Conflict of interest
TJM reports consultant fees from G&W Labs, BMS, and NHC, all unrelated to this research; EMP is an employee of the National Health Council, which receives membership dues and sponsorship funding from a wide range of organizations. For the full list, please see www.nhcouncil.org; JFS reports grants from the PhRMA Foundation and PhRMA unrelated to this work; SK reports grants from Gilead Sciences, Merck, and Arbutus Pharma; CDM reports grants from Merck and consulting fees from Bayer, Boehringer-Ingelheim, Illumina, Janssen, Merck, Pfizer, Regeneron, and Sanofi.
- 6.Leidner AJAJ, Chesson HWHW, Spradling PRPR, Holmberg SDSD. Assessing the effect of potential reductions in non-hepatic mortality on the estimated cost-effectiveness of hepatitis C treatment in early stages of liver disease. Appl Health Econ Health Policy. Springer International Publishing; 2016;15:1–10.CrossRefGoogle Scholar
- 7.Chhatwal J, He T, Lopez-Olivo MA. Systematic review of modelling approaches for the cost effectiveness of hepatitis C treatment with direct-acting antivirals. Pharmacoeconomics. Springer International Publishing. 2016;34:551–67.Google Scholar
- 11.Institute for Quality and Efficiency in Health Care. Choice-based Conjoint Analysis -- Pilot Project to Identify, Weight, and Prioritize Multiple Attributes in the Indication "Hepatitis C" [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2014 Jul 23. Available from http://www.ncbi.nlm.nih.gov/books/NBK385771/
- 15.Tice JA, Ollendorf DA, Chahal HS, Kahn JG, Marseille E, Weissberg J, et al. The comparative clinical effectiveness and value of novel combination therapies for the treatment of patients with genotype 1 chronic hepatitis c infection: a technology assessment. Institute for Clinical and Economic Review. 2015 Jan 30. Available from https://icer-review.org/wp-content/uploads/2016/01/CTAF_HCV2_Final_Report_013015.pdf
- 17.Patient-Centred Outcomes Research Institute. Engaging an underserved patient community to inform and improve comparative effectiveness research for hepatitis C treatments [Internet]. 2018. https://www.pcori.org/research-results/2017/engaging-underserved-patient-community-inform-and-improve-comparative. Accessed 22 Oct 2018.
- 19.Helmer O. Analysis of the future: the Delphi method. California: Santa Monica; 1967.Google Scholar
- 20.Hsu C, Sandford B. The delphi technique: making sense of consensus. Pract. Assessment, Res Eval. 2007;12:1–8.Google Scholar
- 22.Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. Sage publications; 2017.Google Scholar
- 26.Do A, Mittal Y, Liapakis A, Cohen E, Chau H, Bertuccio C, et al. Drug authorization for sofosbuvir/ledipasvir (harvoni) for chronic HCV infection in a real-world cohort: a new barrier in the HCV care cascade. PLoS One. 2015;10:1–15.Google Scholar
- 27.Dunn EEE, Vranek K, Hynicka LMM, Gripshover J, Potosky D, Mattingly TJJ. Evaluating a Collaborative Approach to Improve Prior Authorization Efficiency in the Treatment of Hepatitis C Virus. Qual. Manag. Health Care [Internet]. 2017;26:136–9. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85021814470&doi=10.1097%2FQMH.0000000000000137&partnerID=40&md5=5d46b90ebb71fec39f3605f662591787.
- 36.Richmond JA, Ellard J, Wallace J, Thorpe R, Higgs P, Hellard M, et al. Achieving a hepatitis C cure: a qualitative exploration of the experiences and meanings of achieving a hepatitis C cure using the direct acting antivirals in Australia. Hepatol Med Policy. 2018;3:1–9.Google Scholar
- 38.Lakdawalla DN, Doshi JA, Garrison LP, Phelps CE, Basu A, Danzon PM. Defining elements of value in health care—a health economics approach: an ISPOR special task force report . Value Heal. Elsevier Inc.; 2018;21:131–9.Google Scholar
- 41.Garson GD. Grounded theory. 2016th ed. Asheboro: Statistical Associates Publishers; 2016.Google Scholar