Adoption of direct-acting antiviral medications for hepatitis C: a retrospective observational study.
Abstract
<h4>Background</h4>Approximately 3.5 million Americans are infected with the hepatitis
C virus (HCV). Although many patients with HCV are asymptomatic, HCV is the leading
cause of infection-related death in the U.S. With advances in curative medication
therapy for HCV, many of these deaths are preventable. Access to innovative therapies
may be unevenly distributed. Our objective was to describe medication prescribers'
adoption of innovative HCV pharmacotherapy across prescriber, geographical location,
and time.<h4>Methods</h4>This is a retrospective, secondary data analysis among a
national cohort of patients prescribed direct-acting antiviral HCV medications with
curative intent. We assessed prescriptions by time, geographic location, and provider
type.<h4>Results</h4>The peak of the adoption rate occurred within 45 days; nearly
one-sixth of all prescribers had already prescribed one of the new drugs. Geographical
regions (Midwest, South, and West all p ≥ 0.05) nor gender (p = 0.455) of a prescriber
impacted adoption. Similarly, patient income did not influence the likelihood of a
prescriber to adopt the new drugs earlier (p = 0.175). Gastroenterologists or hepatologists
were more likely earlier adopters compared to primary care physicians (p = 0.01).<h4>Conclusions</h4>Because
of the relative advantage of newer therapies, we anticipated that there would be an
initial surge as early adopters prescribed the new medications and use would dwindle
over time as the initial HCV cohort was cured. The data demonstrate that our hypothesis
is essentially supported. There is a reduction in prescriptions at approximately 5
months post-approval and treatment is typically required for 3 months. There has been
a surge in clinicians' adoption of innovative HCV treatments. As patients are cured
of their infection, we anticipate a decreased need for chronic management of HCV.<h4>Trial
registration</h4>Not applicable.
Type
Journal articleSubject
HumansHepatitis C
Antiviral Agents
Therapies, Investigational
Retrospective Studies
Geography
Time Factors
Adult
Physicians
United States
Female
Male
Healthcare Disparities
Drug Prescriptions
Practice Patterns, Physicians'
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https://hdl.handle.net/10161/25537Published Version (Please cite this version)
10.1186/s12913-019-4349-xPublication Info
Zullig, Leah L; Bhatia, Haresh L; Gellad, Ziad F; Eatherly, Mark; Henderson, Rochelle;
& Bosworth, Hayden B (2019). Adoption of direct-acting antiviral medications for hepatitis C: a retrospective observational
study. BMC health services research, 19(1). pp. 521. 10.1186/s12913-019-4349-x. Retrieved from https://hdl.handle.net/10161/25537.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Hayden Barry Bosworth
Professor in Population Health Sciences
Dr. Bosworth is a health services researcher and Deputy Director of the Center of
Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham
VA Medical Center. He is also Vice Chair of Education and Professor of Population
Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke
University Medical Center and Adjunct Professor in Health Policy and Administration
at the School of Public Health at the University of North Carolina at Cha
Ziad F. Gellad
Associate Professor of Medicine
Dr. Gellad is an associate professor of medicine in the Division of Gastroenterology
at Duke University Medical Center and a faculty member of the Duke Clinical Research
Institute. He is also a VA Career Development Awardee and holds an appointment in
the Health Services Research and Development Center of Innovation at the Durham VA
Medical Center. His research focuses on the implementation of systems engineering
methods to improve the quality and value of health care delivery wit
Leah L Zullig
Professor in Population Health Sciences
Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist.
She is a Professor in the Duke Department of Population Health Sciences and an investigator
with the Center of Innovation to Accelerate Discovery and Practice Transformation
(ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching
research interests address three domains: improving cancer care delivery and quality;
promoting cancer survivorship and chr
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