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INFECTIOUS DISEASES

Use of Specialty Care Versus Standard Retail Pharmacies for Treatment of Hepatitis C

Director and Associate Professor of Medicine, Section of Hepatology, Rush University Medical Center, Chicago, IL

Mary J Kwasny, ScD

Assistant Professor of Biostatistics, Department of Community and Mental Health Nursing and Health Systems Management, Rush University Medical Center

Joseph Ahn, MD MS

Assistant Professor of Medicine, Section of Hepatology, Rush University Medical Center

Reprints: Dr. Cohen, Section of Hepatology, Rush University Medical Center, 1725 W. Harrison St., Ste. 158, Chicago, IL 60612, fax 312/563-4215, stanley_m_cohen{at}rush.edu

BACKGROUND: Treatment for hepatitis C virus (HCV) is associated with significant adverse events. Improved adherence increases the probability of achieving sustained virologic response (SVR). Despite a lack of supporting literature, the use of specialty care pharmacies has increased in recent years in an attempt to improve HCV treatment outcomes.

OBJECTIVE: To compare specialty care versus standard retail pharmacies in HCV treatment outcomes, utilization of office resources, and the use of supplemental medications.

METHODS: A retrospective chart review was performed at a single academic institution for adults with HCV infection treated between 2001 and 2006. SVR was the primary endpoint. Secondary endpoints included therapy completion rates, HCV treatment dose reductions, additional phone calls and clinic visits, and the use of supplemental medications.

RESULTS: One hundred ninety-seven patients were identified (102 standard and 95 specialty care pharmacy). There were no differences in baseline demographics between the groups, except for a higher proportion of African Americans using specialty care pharmacies. Overall SVR was 103/197 (52%). SVR was 57/102 (56%) in the standard pharmacy group and 46/95 (48%) in the specialty care pharmacy group. There were no statistically significant differences with regard to SVR (even after accounting for differences in ethnicity), the use of supplemental medications, additional clinic phone calls and visits required, and the reasons for HCV therapy discontinuation. There was a statistically significantly higher incidence of HCV medication dose reductions in the standard retail pharmacy group (45% vs 28%; p = 0.016).

CONCLUSIONS: The use of specialty care pharmacies for the treatment of HCV was not associated with higher SVR rates. Patients using specialty care pharmacies had a lower incidence of interferon and/or ribavirin dose reductions, but there was no difference between the groups in therapy completion rates, use of additional office resources, or use of supplemental medications.

Key Words: adherence, hepatitis C, specialty care pharmacy, standard retail pharmacy, sustained virologic response

Published Online, January 27, 2009. www.theannals.com, DOI 10.1345/aph.1L227