The utilization of 8 weeks of sofosbuvir/ledipasvir single-tablet direct-acting antiviral regimen amongst the population indicated for the treatment in the United States
AASLD LiverLearning®. Heinz S. Nov 14, 2016; 144849
Topic: Treatment
Dr. Sabina Heinz
Dr. Sabina Heinz
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TITLE: The utilization of 8 weeks of sofosbuvir/ledipasvir single-tablet direct-acting antiviral regimen amongst the population indicated for the treatment in the United States


Methods: Ipsos’ Hepatitis C Virus (HCV) Therapy Monitor reports on ~150 physicians per quarter across the United States. Physicians provide patient demographic, disease and treatment data on HCV patients seen within each period. The US HCV Therapy Monitor Q4 2014-Q1 2016 data (excluding patients that have achieved or are awaiting sustained virologic response) was used to analyze the population of patients eligible for an 8-week treatment length of the sofosbuvir/ledipasvir (SOF+LED) single-tablet direct-acting antiviral (DAA) regimen and those utilizing this treatment length in their current regimens. Patients eligible for the 8-week treatment length with SOF+LED are genotype 1, treatment naïve, non-cirrhotic, and have an HCV RNA concentration of less than 6 million IU/mL. Patients lacking a viral load score and/or fibrosis level were excluded from the eligibility adjudication.
Results: From Q4’14 - Q1’16, 41% of the 8,417 patients in the study were eligible for 8 weeks of SOF+LED. 43% of the eligible patients were currently treated. The treatment rate is higher amongst the cohort ineligible for 8 weeks of treatment at 48%. In comparing the treated and untreated patients eligible for 8 weeks of SOF+LED, the treated are significantly more likely to have moderate to severe fibrosis, traditional indemnity insurance, and be free of substance abuse.
Of the 735 patients currently on SOF+LED, and eligible for the shorter treatment length, only 30% were expected to finish treatment in 8 weeks. This proportion has not changed notably since SOF+LED was launched in Q4’14. Compared to the SOF+LED patients expected to finish in 8 weeks, those expected to finish in >8 weeks were more likely co-infected with HIV, beneficiaries of Medicaid, and over the age of 60.
Conclusion: The analysis revealed that while 41% of the patient population is eligible for an 8-week treatment length of SOF+LED, less than half have access to treatment and even a smaller proportion are expected to finish SOF+LED in 8 weeks. These untreated patients eligible for an 8 week course are likely facing access issues related to their lower fibrosis scores and health insurance coverage through public payers. 12 weeks of treatment is anticipated amongst the majority of SOF+LED patients eligible, but not expected, to finish in 8 weeks. This represents a 50% increase in treatment length, and possibly cost, both of which could be avoided. With the higher cost and compliance risk associated with a longer treatment, it’s imperative that all stakeholders in the Hepatitis C universe leverage the best possible solutions to eradicate the virus’s presence.
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