HCV Antimicrobial Stewardship Program decreases costs, length of therapy

NEW ORLEANS — Data from a retrospective study presented at IDWeek 2016 indicated the implementation of a Hepatitis C Virus Antimicrobial Stewardship Program resulted in comparable sustained virologic response rates and reduced treatment costs.

“The concept of stewardship can and should be applied to everything,” Katherine Pleasants, PharmD, of the Ralph H. Johnson VA Medical Center, told Healio.com/Hepatology. “We were able to focus on cost in this project, as the drug therapy had comparable efficacy. However, especially as new HCV drug therapies are available, it is important to step back and always assess the specific cure rates and outcomes associated with each agent.”

In the study, Pleasants and colleagues evaluated patients with HCV genotype 1 who began treatment with either Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) or Viekira Pak (ombitasvir, paritaprevir and ritonavir tablets with dasabuvir tablets, AbbVie).

Results showed 76.7% of patients who initiated treatment prior to the HCV Antimicrobial Stewardship Program reached SVR12 (n = 69/90) comparable with 88% who began treatment after implementation (n = 22/25). After implementation, the average treatment cost per patient decreased by $6,083.86 in patients without cirrhosis and by $15,278 in patients with cirrhosis.

“In our clinical research, the Antimicrobial Stewardship pharmacist was able to significantly reduce the cost of treatment of HCV,” Pleasants said. “Essentially, the Antimicrobial Stewardship pharmacist ensured treatment that was so cost-effective, that two HCV patients could be treated with what originally was the cost to treat only one patient.”

The program interventions were associated with an 18% decrease in treatment duration for patients without cirrhosis and 27.6% for patients with cirrhosis.

Twenty-percent of the pre-implementation group and 12% of the post-implementation group were non-compliant with follow-up.

While barriers to implementation of a stewardship program may still arise, such as a pharmacist having the right HCV expertise to treat, Pleasants said with the AASLD and IDSA recommendations for increased testing, this should increase the likelihood of more programs like this.

“Now that the AASLD/IDSA HCV guidelines are recommending all HCV patients are treated, the flood gates have opened and we are treating as many patients as possible as quickly as we can,” Pleasants said. “Every patient deserves to be treated and cured of HCV.”

Pleasants said she and colleagues will continue to use first-line drug therapies that are recommended by the AASLD/IDSA guidelines and have also adjusted their model for treating HCV patients to incorporate Ambulatory Care Pharmacists to be more involved.

“HCV pharmacists could play an essential role in selecting drug therapy in these more complex patients.” — by Melinda Stevens

Reference:

Pleasants K, et al. Abstract 1791. Presented at: IDWeek; October 25-30, 2016; New Orleans.

Disclosure: The researchers report no relevant financial disclosures.