Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 601E Ford Bldg, University Park, PA 16801. Email:
Am J Manag Care. 2020 Feb;26(2):84-88. doi: 10.37765/ajmc.2020.42397.
To examine factors associated with discontinuation of new hepatitis C drugs-second-generation direct-acting antivirals (DAAs)-among Medicare beneficiaries with chronic hepatitis C.
A retrospective analysis using 2014-2016 Medicare claims.
The study population was patients with chronic hepatitis C in fee-for-service Medicare with Part D who initiated a DAA therapy between January 1, 2014, and September 1, 2016. We defined discontinuation of DAA therapy as filling prescriptions for fewer weeks than the expected duration of the DAA identified. We estimated adjusted odds ratios (aORs) of DAA discontinuation by patient characteristics using multivariable logistic regression. We estimated the model separately for patients with a Part D low-income subsidy (LIS) and those without an LIS.
Of 82,056 patients who initiated a DAA therapy during the study period, 5171 (6.3%) did not complete the therapy. Discontinuation rates varied across DAAs, ranging from 4.7% (elbasvir/grazoprevir) to 11.8% (ombitasvir/paritaprevir/ritonavir/dasabuvir). Women with an LIS were more likely to discontinue DAA therapy than men with an LIS (aOR, 1.16; 95% CI, 1.08-1.25; P <.01). Non-LIS black and Hispanic patients had higher odds of discontinuation than non-LIS white patients (black: aOR, 1.49; 95% CI, 1.28-1.73; P <.01; Hispanic: aOR, 1.56; 95% CI, 1.01-2.44; P <.05). High comorbidity index score increased the odds of DAA discontinuation among patients with an LIS.
Real-world discontinuation of DAA therapy was low, but it was 3 times more likely than in clinical trials and varied by patient characteristics. Efforts to increase DAA adherence would help lower patients' risk of developing resistance to future treatments and reduce potential waste of resources.
在接受医疗保险的慢性丙型肝炎患者中，研究与新型丙型肝炎药物（第二代直接作用抗病毒药物）停药相关的因素。
使用 2014 年至 2016 年医疗保险索赔数据进行回顾性分析。
研究人群为在接受医疗保险的付费服务中患有慢性丙型肝炎且参加医疗保险处方药计划（Part D）的患者，这些患者在 2014 年 1 月 1 日至 2016 年 9 月 1 日期间开始使用 DAA 治疗。我们将 DAA 治疗中断定义为开具的处方少于预期 DAA 治疗疗程的周数。我们使用多变量逻辑回归估计了患者特征与 DAA 停药之间的调整比值比（aOR）。我们分别对有和没有医疗保险处方药计划低收入补贴（LIS）的患者进行了模型估计。
在研究期间开始使用 DAA 治疗的 82056 名患者中，有 5171 名（6.3%）未完成治疗。不同 DAA 的停药率不同，范围从 4.7%（elbasvir/grazoprevir）到 11.8%（ombitasvir/paritaprevir/ritonavir/dasabuvir）。有 LIS 的女性比有 LIS 的男性更有可能停止 DAA 治疗（aOR，1.16；95%CI，1.08-1.25；P<.01）。非 LIS 的黑人和西班牙裔患者比非 LIS 的白人患者更有可能停药（黑人：aOR，1.49；95%CI，1.28-1.73；P<.01；西班牙裔：aOR，1.56；95%CI，1.01-2.44；P<.05）。高合并症指数评分增加了 LIS 患者停止 DAA 治疗的几率。
真实世界中 DAA 治疗的停药率较低，但比临床试验中高 3 倍，且因患者特征而异。增加 DAA 依从性的努力将有助于降低患者对未来治疗产生耐药的风险，并减少潜在的资源浪费。
