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PWE-053 Individualised, cost-effective hepatitis C virus treatment – the tailored Taunton algorithm achieves equal sustained virological response with less weeks of combined anti-viral therapy
  1. M Naseer1,
  2. W Matull2,
  3. A Tarr2,
  4. P D Thomas2,
  5. S Pugh2
  1. 1Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
  2. 2Gastroenterology, Musgrove Park Hospital Taunton and Somerset NHS Trust, Taunton, UK

Abstract

Introduction Measurement of rapid viral response (RVR; non-detectable viral load (ND-VL) at 4/52) and early viral response (EVR; ND-VL at 12/52) allow treatment to be individually tailored. Our hepatitis C (HCV) treatment protocol (“standard”=SP) was changed in 2007, from 24/52 for genotype (GT) 2+3, 48/52 for GT1+4 (if EVR) to an “individualised” new protocol (IP): 16/52 for GT2+3 and 24/52 for GT1+4 if RVR; standard length (24 or 48/52) if full EVR; and pro-longed (48 or 72/52) if partial EVR (>2log-VL-reduction at 12/52).

Methods Retrospective case note analysis of HCV patients treated between 01.01.2006–31.12.2008; n=74. 24 patients were managed according to SP, 50 according to IP. Health professionals, medication (Peg-INF-2α+Ribavirin) and dosages did not change. Primary outcome was sustained virological response (SVR) (ND-VL 6/12 after treatment end). Secondary outcome was “mean length of treatment” and “overall treatment costs”.

Results The two cohorts (SP/IP) were similar with regards to age (mean;42 years/44 years), sex (M;60%/50%), weight (mean;81 kg/75 kg), GT (2+3;75%/72%) and baseline VL (mean; 1×106/3×106). 80% (59/74) were pre-cirrhotic and treatment-naïve. Dropout-rates were 20% (5/24) for SP, 20% (10/50) for IP. On intention-to-treat (ITT), 50% (12/24) of SP-managed patients achieved SVR, compared with 58% (29/50) with IP (p=0.62). Per-protocol analysis (PPA) revealed 63% (12/19) SVR for SP and 70% (28/40) SVR for IP (p=0.76). The following table shows the average length of treatment and overall costs (drug estimates) according to GT and protocol (Abstract 053).

Abstract PWE-053

Average treatment length and cost according to genotype and protocol

Conclusion The individualised treatment protocol was non-inferior to standard in achieving SVR. On average, we saved £10 200 for GT1+4 patients and £3000 for GT2+3. This equates to approximately £162 000 per year (for 30 patients treated). Those savings shall be reinvested (eg, specialist hepatitis nurse provision), which is likely to translate into reduced dropout rates and higher SVR.

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