National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Formos Med Assoc. 2019 Jun;118(6):1014-1023. doi: 10.1016/j.jfma.2018.10.020. Epub 2018 Nov 15.
BACKGROUND/PURPOSE: While direct-acting antiviral regimens have been approved for chronic hepatitis C (CHC) patients in Taiwan, reimbursement is limited to certain populations. Thus, pegylated interferon plus ribavirin (PEG-IFN/RBV) remains the standard of care for many patients. The aim of this study was to investigate the percentage of CHC patients who were recommended and willing to receive PEG-IFN/RBV, and to identify reasons why patients were not recommended or unwilling to receive treatment.
822 Taiwanese CHC patients were enrolled from May-August 2016 in this cross-sectional study. PEG-IFN/RBV recommendation and patient willingness to receive treatment were evaluated through surveys. Patient characteristics associated with treatment recommendation and willingness were assessed.
311 (37.8%) patients were recommended PEG-IFN/RBV while 102 (12.4%) were willing to follow treatment recommendation. Rates of recommendation and willingness were lower in treatment-experienced, hepatitis C virus genotype 1 (GT1) and cirrhotic patients, and those treated in Northern Taiwan. Multivariate analyses found factors such as prior treatment experience, GT1, cirrhosis and low hemoglobin levels to be associated with lower recommendation rates while advanced age, GT1 and low baseline viral loads were associated with lower willingness rates. Physicians' top reasons for not recommending PEG-IFN/RBV included the wish to wait for better treatment options (60.3%), prior treatment failure (21.3%) and patients' advanced age (20.9%). Patients were unwilling to receive treatment mainly due to concerns about side effects (91.4%), the wish to wait for better treatment options (71.3%) and inconvenience (25.4%).
A minority of Taiwanese CHC patients were recommended PEG-IFN/RBV, of which few were willing to receive treatment.
背景/目的：虽然直接作用抗病毒药物已在台湾被批准用于慢性丙型肝炎（CHC）患者，但报销范围仅限于某些人群。因此，聚乙二醇干扰素联合利巴韦林（PEG-IFN/RBV）仍然是许多患者的标准治疗方法。本研究旨在调查推荐和愿意接受 PEG-IFN/RBV 治疗的 CHC 患者的比例，并确定患者未被推荐或不愿接受治疗的原因。
本横断面研究于 2016 年 5 月至 8 月期间招募了 822 名台湾 CHC 患者。通过调查评估 PEG-IFN/RBV 的推荐和患者接受治疗的意愿。评估了与治疗建议和意愿相关的患者特征。
311 名（37.8%）患者被推荐接受 PEG-IFN/RBV 治疗，而 102 名（12.4%）愿意接受治疗建议。在有治疗经验、丙型肝炎病毒基因型 1（GT1）和肝硬化患者以及在北部台湾接受治疗的患者中，推荐和愿意接受治疗的比例较低。多变量分析发现，先前的治疗经验、GT1、肝硬化和低血红蛋白水平等因素与较低的推荐率相关，而年龄较大、GT1 和低基线病毒载量与较低的意愿率相关。医生不推荐 PEG-IFN/RBV 的主要原因包括希望等待更好的治疗选择（60.3%）、先前治疗失败（21.3%）和患者年龄较大（20.9%）。患者不愿接受治疗主要是由于担心副作用（91.4%）、希望等待更好的治疗选择（71.3%）和不便（25.4%）。
台湾 CHC 患者中只有少数被推荐接受 PEG-IFN/RBV 治疗，其中愿意接受治疗的患者比例较低。
