Predictors of hepatitis C virus treatment in Veterans

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Predictors of hepatitis C virus treatment in Veterans

A study in the latest issue of the American Journal of Gastroenterology reports on the importance of patient, provider, and facility predictors of hepatitis C virus treatment in veterans.Several patient characteristics are known to impact hepatitis C virus antiviral treatment rates.However, it is unclear whether, and to what extent, health-care providers or facility characteristics impact hepatitis C virus treatment rates.Using national data obtained from the Department of Veterans Affairs (VA) hepatitis C virus Clinical Case Registry, Dr Kramer and colleagues from Texas, USA conducted a retrospective cohort study of patients with active hepatitis C virus viremia, who were diagnosed between 2003 and 2004.The research team evaluated patient-, provider-, and facility-level predictors of receipt of hepatitis C virus treatment with hierarchical logistic regression.Patients with high hemoglobin levels were more

likely to receive treatmentThe overall hepatitis C virus treatment rate in 29,695 patients was 14%.The strongest independent predictor for receipt of treatment was consultation with an hepatitis C virus specialist.The research team found that patients were less likely to receive hepatitis C virus treatment if they were Black, older, male, current users of alcohol or drugs, had hepatitis C virus genotype 1 or 4, had higher creatinine levels, or had severe anxiety/post-traumatic stress disorder or depression.Patients with high hemoglobin levels, cirrhosis, and persistently high liver enzyme levels were more likely to receive treatment.Patient, provider, and facility factors explained 15, 4, and 4%, respectively, of the variation in treatment rates.Treatment rates for hepatitis C virus are low in the VA.In addition to several important patient-level characteristics, the researchers found that a specialist

consultant has a vital role in determining whether a patient should receive hepatitis C virus treatment.Dr Kramer's team concludes, "These findings support the development of patient-level interventions targeted at identifying and managing comorbidities, and contraindications and fostering greater involvement of specialists in the care of hepatitis C virus."Am J Gastroenterol 2011; 106: 483–9121 March 2011

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