Date of Award

2017

Document Type

Thesis

Degree Name

Master of Science (M.S.)

Department

Pharmaceutical and Chemical Sciences

First Advisor

William A. Kehoe

First Committee Member

Sian Carr-Lopez

Second Committee Member

Rajul A. Patel

Third Committee Member

John Livesey

Abstract

Background: Hepatitis C virus is currently the most common chronic blood borne pathogen in the United States, with only half of those infected aware of their condition. The cost for treatment is higher with Harvoni® (ledipasvir/sofosbuvir) than Viekira Pak® (ombitasvir/paritaprevir/ritonavir and dasabuvir). With finite resources available to treat patients, it is important to understand which clinical factors may influence treatment selection decisions.

Methods: The study is a 12-month medical record review within the Veterans Affairs (VA) system to evaluate significant relationships between selected clinical and sociodemographic factors and HCV treatment selection with either Harvoni® or Viekira Pak®. Clinical and demographic information was collected as well a presence of interacting medications, contraindication to components of the treatment regimen, and the treatment regimen indicated and selected.

Results: In total, 25,717 patients were extracted from the database and were compared by the use of frequency charts and logistic regression analysis with results reflective of the nationally reported numbers. There was a statistically significant difference in the prescribing pattern between the VA Northern California Health System (station 612) and the other stations nationally with Viekira Pak® prescribed more often in that station. Station 612 utilized an electronic decision tree (otherwise known as a ‘quick order’) during the medication ordering process. In a comparison between station 612 and the other stations within the VA a notable difference in the impact of drug-drug interactions on the prescribing patterns was found within station 612.

Conclusion: Many methods can be used to ensure optimal treatment for HCV infections. In station 612 the use of a decision tree may have assisted in avoidance of potentially modifiable factors which enabled for a higher utilization of the less expensive treatment option, Viekira Pak®, for HCV infections, thereby potentially allowing for more Veterans to be treated with finite resources.

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