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A comparison of hepatitis C treatment and outcomes at academic, private and Veterans' Affairs treatment centers
D. M. Jensen, S. J. Cotler, H. Lam, G. Harb & A. Shillington

Summary
Background: Currently, there is a lack of published data examining hepatitis C treatment practices in different care settings.
Aim: To provide data describing treatment practices for patients with hepatitis C virus infection in actual clinical practice, and to examine clinical outcomes in patients treated with interferon alpha-2b/ribavirin combination therapy in academically affiliated centers, private treatment centers and Veterans' Affairs treatment centers.

Methods: This multi-centre, retrospective, cohort study of 231 patients examined hepatitis C virus treatment practices in patients receiving interferon alpha-2b from January 1997 to May 2001 and explored outcomes in academically affiliated, private and Veterans' Affairs centers.

Results: Differences in treatment practice and use of diagnostic procedures were found. Genotype testing was under-utilized in non-academic sites (academic centers, 79.2%; private centers, 33.7%; Veterans' Affairs centers, 35.9%; P < 0.001). Liver biopsies were performed less often in private sites (academic centers, 95.8%; private centers, 80.0%; Veterans' Affairs centers, 92.2%; P < 0.01). End-of-treatment viral response (academic centers, 40.0%; private centers, 31.3%; Veterans' Affairs centers, 17.2%; P < 0.05) was lower than that found in published trial data. Multivariate analysis revealed genotype 1 as the single significant predictor of treatment failure (P < 0.01).

Conclusions: Outside of the academic setting, there is significantly less diagnostic work-up performed prior to the initiation of hepatitis C virus therapy. This suggests a need for a standardization of care across treatment settings.

http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2036.2003.01817.x/abs/;jsessionid=e3nGnn0TOoF5