Implementation of treatment recommendations for chronic hepatitis B in patients attending specialized hospital care in Denmark – a region wide study

Abstract

Objective: To evaluate implementation of national guideline recommendations on treatment initiation for chronic hepatitis B (CHB) in Denmark.

Methods: Using DANHEP, a nationwide cohort of chronic hepatitis B and C patients attending specialized hospital care in Denmark, we performed a descriptive cohort study from January 2002 through December 2017. We identified patients with CHB in 3 of 5 Danish regions, with at least two hospital/outpatient clinic visits during the study period.

Results: We identified 990 CHB patients who remained untreated throughout the study period, and 265 who initiated treatment. At their last visit 952/990 (96%, 95% CI 95–97) untreated patients did not meet current national criteria for treatment initiation while 198/265 (75%, 95% CI 69–80) who initiated treatment met the national criteria. Overall, 198/236 (84%, 95% CI 79–88) who met national treatment criteria, initiated treatment.

Conclusion: The majority of CHB patients received care in line with national guideline recommendations for treatment initiation. We found that only few patients eligible for treatment remained untreated. However, a fourth of patients who received treatment were not eligible according to national guidelines.

Keywords:

• Chronic hepatitis B
• antiviral therapy
• Denmark
• guideline implementation
• adherence
• recommendations

Acknowledgments

The authors thank all patients who contributed data to DANHEP.

Disclosure statement

OB, PT, UB, HM, TB, LH, JG, HK, and MRC declare no conflicts of interest. SH and SB were unpaid speakers at MSD sponsored events. SH received bursary from EASL for participation in International Liver Conference, Barcelona, 2016, and has received an honorarium for speaking at the HIV and Hepatitis Nordic Conference, Stockholm, 2018. NW has been a clinical investigator, lecturer or member of advisory boards for Abbvie, BMS, MSD and Gilead and has received unrestricted grants for research from Abbvie and Gilead. LGM has been clinical investigator, lecturer or member of advisory boards for Norgine, BMS and Abbvie.

Data availability statement

The data that support the findings of this study are not publicly available as this would compromise the privacy of persons included in DANHEP.

Additional information

Funding

This study was funded by Manufacturer Vilhelm Pedersen and wife's fund; University hospital of Copenhagen, Hvidovre and Amager; Carpenter Jørgen Holm and wife Elisa f. Hansen's memorial fund.