Home > Full Text Reviews > Peginterferon Alfa and Ribavirin for... > Assessment of factors relevant to the...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Hartwell D, Jones J, Baxter L, et al. Peginterferon Alfa and Ribavirin for Chronic Hepatitis C in Patients Eligible for Shortened Treatment, Re-Treatment or in HCV/HIV Co-Infection: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Journals Library; 2011 Apr. (Health Technology Assessment, No. 15.17.)

6Assessment of factors relevant to the NHS and other parties

It should be acknowledged that the lower limits of detection for HCV RNA in terms of RVR and SVR differed slightly between the RCTs included in our systematic review of clinical effectiveness, according to the different assays used. For example, RVR was defined as HCV RNA < 50 IU/ml in three of the trials, < 25 IU/ml in one trial, < 600 IU/ml in one trial and < 615 IU/ml in another. Although a detectable HCV viral load of 50 IU/ml or above is generally considered indicative of infection, thresholds of detectability are becoming lower as more sophisticated assays are being produced. It is therefore important to achieve standardisation in definitions of virological response, particularly given the increased emphasis on using RVR to determine optimum treatment duration. Similarly, there is a lack of clarity regarding thresholds for LVL and high viral load. The SPC for the two peginterferons vary in terms of what they consider to be LVL (varying between < 600,000 IU/ml and ≤ 800,000 IU/ml). Again, clarity is needed regarding viral load thresholds to ensure consistent clinical management of patients.

If patients with specific genotypes meeting the licence criteria received shortened courses of antiviral treatment, then they would benefit in terms of reduced exposure to adverse effects, which can be very unpleasant and have a profound impact on a person's day-to-day life, as well as that of family and carers. Consequently, it may also mean that less time is lost from work, thereby having an impact on economic circumstances.

Initiatives to encourage people who may have put themselves at risk of HCV infection, such as the Department of Health's ‘FaCe It’ campaign, need to be maintained to reduce the substantial pool of undiagnosed infection. As well as the government, the voluntary sector also plays a key role in public awareness raising. Efforts to identify HCV infections need to be augmented by appropriate methods of referral to specialist care for further investigation and, if appropriate, antiviral treatment. Referral mechanisms need to be effective to ensure that as many eligible patients progress through the care pathway to be successfully treated. Strategies are also needed to motivate patients to attend assessment appointments and to complete the full course of therapy. This may be more problematic for patients with co-infection with HIV, who may not perceive their infection to be serious enough to undergo further assessment and treatment, particularly given the unpleasant adverse effects associated with interferon. Motivation is also particularly important for people who use drugs and alcohol, whose lifestyles are often unpredictable, making concordance with treatment regimes difficult. Such responsibilities may fall to specialist hepatology nurses, as well as general practitioners and other services. However, these may be time and resource intensive, and will be subject to budget constraints.

In terms of implementation issues, there do not appear to be any significant barriers to diffusion of the appraised treatments into routine practice. Peginterferon alfa has been the standard of care for some time. Specialist hepatology nurses will already be familiar with the administration of these drugs in the treatment of HCV. However, management protocols will need to be updated, where necessary, to ensure efficient testing for RVR and viral load to identify which patients are likely to be successfully treated with shorter courses.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Cover of Peginterferon Alfa and Ribavirin for Chronic Hepatitis C in Patients Eligible for Shortened Treatment, Re-Treatment or in HCV/HIV Co-Infection: A Systematic Review and Economic Evaluation
Peginterferon Alfa and Ribavirin for Chronic Hepatitis C in Patients Eligible for Shortened Treatment, Re-Treatment or in HCV/HIV Co-Infection: A Systematic Review and Economic Evaluation.
Health Technology Assessment, No. 15.17.
Hartwell D, Jones J, Baxter L, et al.
Southampton (UK): NIHR Journals Library; 2011 Apr.

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...