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Huge gap between clinical efficacy and community effectiveness in the treatment of chronic hepatitis C: a nationwide survey in Taiwan.

  • Yu, Ming-Lung
  • Yeh, Ming-Lun
  • Tsai, Pei-Chien
  • Huang, Ching-I
  • Huang, Jee-Fu
  • Huang, Chung-Feng
  • Hsieh, Meng-Hsuan
  • Liang, Po-Cheng
  • Lin, Yi-Hung
  • Hsieh, Ming-Yen
  • Lin, Wen-Yi
  • Hou, Nai-Jen
  • Lin, Zu-Yau
  • Chen, Shinn-Cherng
  • Dai, Chia-Yen
  • Chuang, Wan-Long
  • Chang, Wen-Yu
Published Article
Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins
Publication Date
Apr 01, 2015
DOI: 10.1097/MD.0000000000000690
PMID: 25837762


Peginterferon/ribavirin provides a substantially high treatment efficacy for chronic hepatitis C virus (HCV) infections in Asians. Whether the clinical efficacy can be translated to community effectiveness remains unclear. The disease awareness, treatment accessibility, recommendations, acceptance, and barriers to anti-HCV treatment were explored to clarify the issue with a 3-step nationwide investigation in Taiwan. A crude HCV-infected population was estimated using databases from 3 large-scale surveillance studies and age-/geographic-specific population database. HCV awareness and accessibility were investigated at the patient level in 58,129 residents. The recommendations/acceptances and barriers to treatment at the provider level were evaluated using a prospective, nationwide approach to 89 gastroenterologists/hepatologists. The estimated 10-year interval age-adjusted anti-HCV-seropositive population is 745,109 (3.28%), with an anticipated HCV-viremic population of 554,361. Of anti-HCV-seropositive subjects, 36.2% had disease awareness. Among those with awareness, 39.6% had accessibility. The recommendation/acceptance rate of antiviral therapy was 70.6%. The treatment rate was 10.1% and 13.7% for the anti-HCV-seropositive and HCV-viremic population, respectively. With an anticipated treatment success rate of 80% in Taiwan, 8.1% of the anti-HCV-seropositive and 10.9% of the HCV-viremic population achieved successful treatment. The major treatment barriers were fear of adverse effects (37%), major disorders (17.6%), ineligibility for insurance reimbursement (17.6%), and lack of therapy awareness (11.3%). Despite the high rates of treatment response and nationwide coverage of insurance reimbursement, there remains a large gap between clinical efficacy and community effectiveness in anti-HCV treatment in Taiwan. Increasing disease awareness/treatment accessibility and introducing new therapeutic strategies with high tolerability are warranted.

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