• José Antonio Carrión, Elena Gonzalez-Colominas, Montserrat García-Retortillo, Nuria Cañete, Isabel Cirera, Susanna Coll, Maria Dolors Giménez, Carmen Márquez, Victoria Martin-Escudero, Pere Castellví, Rica... more rd Navinés, Juan Ramon Castaño, Josep Anton Galeras, Esther Salas, Felipe Bory, Rocío Martín-Santos, and Ricard Solà. less
• Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain. Electronic address: 95565@parc... more desalutmar.cat. less
• J. Hepatol. 2013 Nov 1; 59 (5): 926-33.

Background & AimsAdherence to antiviral treatment is important to achieve sustained virological response (SVR) in chronic hepatitis C (CHC). We evaluated the efficiency of a multidisciplinary support programme (MSP), based on published HIV treatment experience, to increase patient adherence and the efficacy of pegylated interferon alfa-2a and ribavirin in CHC.Methods447 patients receiving antiviral treatment were distributed into 3 groups: control group (2003-2004, n=147), MSP group (2005-2006, n=131), and MSP-validation group (2007-2009, n=169). The MSP group included two hepatologists, two nurses, one pharmacist, one psychologist, one administrative assistant, and one psychiatrist. Cost-effectiveness analysis was performed using a Markov model.ResultsAdherence and SVR rates were higher in the MSP (94.6% and 77.1%) and MSP-validation (91.7% and 74.6%) groups compared to controls (78.9% and 61.9%) (p<0.05 in all cases). SVR was higher in genotypes 1 or 4 followed by the MSP group vs. controls (67.7% vs. 48.9%, p=0.02) compared with genotypes 2 or 3 (87.7% vs. 81.4%, p=n.s.). The MSP was the main predictive factor of SVR in patients with genotype 1. The rate of adherence in patients with psychiatric disorders was higher in the MSP groups (n=95, 90.5%) compared to controls (n=28, 75.7%) (p=0.02). The cost per patient was € 13,319 in the MSP group and € 16,184 in the control group. The MSP group achieved more quality-adjusted life years (QALYs) (16.317 QALYs) than controls (15.814 QALYs) and was dominant in all genotypes.ConclusionsMSP improves patient compliance and increases the efficiency of antiviral treatment in CHC, being cost-effective.Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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