1 Durham VA Health Care System, Durham, North Carolina.
J Manag Care Spec Pharm. 2017 Mar;23(3):364-369. doi: 10.18553/jmcp.2017.23.3.364.
The Veterans Affairs Health (VA) Administration has reported hepatitis C virus (HCV) infection rates among veterans to be twice that of the general U.S population. New HCV direct-acting antiviral (DAA) treatment options offer superior sustained virologic response (SVR) rates, improved side-effect profiles, and shortened treatment courses; yet, these new HCV DAAs are expensive, and utilization management strategies are needed to optimize use and improve clinical outcomes. A VA medical center uses pharmacist-led HCV DAA utilization management strategies that includes clinical guidance, optimizing operational flow, budget tracking and forecasting, and patient outcomes tracking.
To assess the economic and clinical outcomes of pharmacy-led HCV DAA utilization management in a VA medical center.
This was a single-center, retrospective cohort study. Patient electronic health records and the hepatitis C DAA outcomes tracking database were reviewed at a VA medical center. Patients with an HCV DAA prior authorization drug request and therapy initiated between October 1, 2014, and September 30, 2015, were included. The primary endpoint was the ratio of drug spend to cure rate calculated as the total dollars spent to the number of patients achieving SVR at least 12 weeks from end of treatment. Secondary endpoints included economic, clinical, and safety outcomes.
A total of 372 patients were included in the study. The overall cost ratio of total drug spend to cure rate was $40,135.22. The overall cure rate was 94.1%, with no discontinuations due to treatment failure. The ratio of drug spend to cure rate was $41,907.35 and $38,430.77 in cirrhotic and noncirrhotic patients, respectively, and $39,481.62 and $39,178.74 in treatment-experienced and naive patients, respectively. Ten patients discontinued therapy because of the adverse effects of anemia, nausea, vomiting, and anxiety. The medication possession ratio was 98.7% (± 0.13) for all patients included in the study.
This study suggests that pharmacist-led HCV DAA utilization management is an important factor in costs and cure rates. Utilization management strategies are valuable to help adequately manage patients with chronic hepatitis C (CHC) and may allow practitioners to maximize available funding for CHC, while maintaining high efficacy and safety.
No outside funding supported this research. The authors have no conflicts of interest to report. Study concept and design were contributed primarily by Britt, along with Hashem, Brown, and Yang. Yang took the lead in data collection, along with Britt, and data interpretation was performed by all the authors. The manuscript was written and revised by Yang, Britt, Brown, and Hashem.
退伍军人事务部（VA）报告称，退伍军人的丙型肝炎病毒（HCV）感染率是美国普通人群的两倍。新的 HCV 直接作用抗病毒（DAA）治疗方案提供了更高的持续病毒学应答（SVR）率、改善的副作用谱和缩短的治疗疗程；然而，这些新的 HCV DAA 药物昂贵，需要利用管理策略来优化使用并改善临床结果。VA 医疗中心采用药师主导的 HCV DAA 利用管理策略，包括临床指导、优化运营流程、预算跟踪和预测以及患者结果跟踪。
评估 VA 医疗中心的药师主导 HCV DAA 利用管理的经济和临床结果。
这是一项单中心、回顾性队列研究。在 VA 医疗中心，对患者的电子健康记录和丙型肝炎 DAA 结果跟踪数据库进行了审查。纳入 2014 年 10 月 1 日至 2015 年 9 月 30 日期间进行 HCV DAA 事先授权药物请求和治疗的患者。主要终点是药物支出与治愈率的比值，计算方法为治疗结束后至少 12 周达到 SVR 的患者人数与总花费的比值。次要终点包括经济、临床和安全性结果。
共纳入 372 例患者。总的药物支出与治愈率的比值为 40,135.22 美元。总体治愈率为 94.1%，无因治疗失败而停药的病例。肝硬化患者和非肝硬化患者的药物支出与治愈率的比值分别为 41,907.35 美元和 38,430.77 美元，治疗经验丰富的患者和初治患者的比值分别为 39,481.62 美元和 39,178.74 美元。由于贫血、恶心、呕吐和焦虑等不良反应，10 例患者停止治疗。研究中所有患者的药物使用比例为 98.7%（±0.13）。
本研究表明，药师主导的 HCV DAA 利用管理是成本和治愈率的重要因素。利用管理策略对于帮助慢性丙型肝炎（CHC）患者进行适当管理非常有价值，并且可以使医生在保持高疗效和安全性的同时，最大限度地利用 CHC 可用资金。
本研究无外部资金支持。作者没有利益冲突需要报告。研究概念和设计主要由 Britt 提出，同时还有 Hashem、Brown 和 Yang。Yang 与 Britt 一起主要负责数据收集，数据解释由所有作者共同完成。Yang、Britt、Brown 和 Hashem 共同撰写和修订了手稿。
