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研究生:郭琬蓉
研究生(外文):Wan-Jung Kuo
論文名稱:台灣C型肝炎新型直接抗病毒藥物之預算衝擊分析
論文名稱(外文):Budget Impact Analysis of Novel Direct-Acting Antivirals For Hepatitis C Virus Infection in Taiwan
指導教授:郎慧珠郎慧珠引用關係林志陵林志陵引用關係
指導教授(外文):Hui-Chu LangChih-Lin Lin
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:英文
論文頁數:100
中文關鍵詞:C型肝炎預算衝擊分析直接抗病毒藥物
外文關鍵詞:hepatitis C virus infectionbudget impact analysisdirect-acting antivirals
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背景
根據世界衛生組織統計,2015年全球約有七千一百萬人罹患慢性C型肝炎,是目前全球重要公共衛生議題之一。而研究指出,台灣感染率約2-4%,並以基因型第1型及第2型居多。2011年起,C型肝炎直接抗病毒藥物(direct-acting antiviral, DAAs)陸續上市,C型肝炎標準治療正式進入全口服直接抗病毒藥物時代。2017年,DAAs正式開始納入台灣健保給付,但因健保預算有限,第一階段優先給付嚴重程度較高之病人,即曾使用過干擾素和雷巴威林治療無效且Metavir system肝纖維化大於或等於F3;第二階段放寬為不再限制先前曾以干擾素和雷巴威林合併治療無效,只限制Metavir system肝纖維化大於或等於F3才可申請給付。2019年起,新藥給付條件不再設限肝纖維化程度,均可申請健保給付。惟考量臺灣流行病學數據、健保給付條件、醫療成本與國外有很大差異,因此本研究透過健保觀點,利用預算衝擊分析(budget impact analysis, BIA)作進一步的探討。
研究方法
本研究利用台灣C型肝炎流行病學資料及北部某區域醫院健保申報費用推估2019年至
2023年間健保各年度之總醫療費用,並比較兩種不同給付條件下之差異。在每年總治療人數為四萬人之假設下,原情境假設為優先給付DAAs給基因型第1型、抗C型肝炎抗體陽性、C型肝炎病毒RNA陽性、無肝功能代償不全、Metavir system肝纖維化程度大於或等於F3,當上述優先使用對象皆已治療,才開放其他基因型或Metavir system肝纖維化程度小於F3之病人申請給付;而未符合給付條件者則僅可申請使用干擾素和雷巴威林治療;新情境則是不再設限肝纖維化程度,只要確認為慢性C型肝炎感染均可成為全口服新藥給付條件對象。針對具有不確定性的參數之變化範圍進行單維敏感度分析(One way sensitivity analysis)。
研究結果
與原情境相比,各年度之總醫療費用衝擊分別為-12.43億、-12.96億、-13.02億、-13.20億、-13.34億。在敏感度分析中,以抗C型肝炎抗體陽性盛行率與直接抗病毒藥物之平均藥費最有敏感性。
結論
本研究結果顯示,與優先給付Metavir system肝纖維化程度大於或等於F3者之原情境相比,不再設限肝纖維化程度並全面使用全基因型C型肝炎直接抗病毒藥物之新情境具有較低之健保預算衝擊,且差異呈現逐年增加之趨勢。另外,在可能造成不確定性之參數中,以抗C型肝炎抗體陽性盛行率及直接抗病毒藥物費用兩項參數較具影響性,顯示未來可能仍需針對潛在治療人口及實際醫療相關支出進行更深入的探討,以提升預算衝擊分析之準確性。
Background
The direct-acting antivirals (DAAs) have recently shown better treatment outcomes than conventional peginterferon plus ribavirin for the treatment of hepatitis C virus. Taiwan Ministry of Health and Welfare decided to extend coverage for pan-genotypic DAAs to all the patients with hepatitis C, not just severe liver fibrosis or specific genotype in 2019. However, the real impact of extending insurance coverage unconditionally is still unknown.
Objective
This study aimed to assess the budget impact of introducing the pan-genotypic DAAs therapies to all stages and genotypes from the perspective of the Taiwan health care payer.
Methods
A budget impact model was developed with a five-year time horizon (2019-2023) to estimate the
drug-related costs and budget impact on the National Health Insurance. Based on the real-world cost data and modeling assumptions, we compared the two scenarios: the current payment condition, in which patients with F3 or above fibrosis received preferential treatment with DAAs, other patients that do not meet the usage criteria still received interferon-based treatments; the new scenario, with the pan-genotypic DAAs as a first-line treatment for all degrees of fibrosis or cirrhosis. Total annual costs were estimated for patients eligible to have treatment in the target population, and the maximum coverage of 4,0000 patients per year in both scenarios was assumed. A sensitivity analysis was performed with assumptions that differ from those used in the primary analysis.
Results
Compared to the old scenario, extending pan-genotypic DAAs therapies to all stages and genotypes patients showed a budget impact for the reduction of TWD 1,243million, TWD1,296 million, TWD1,302million, TWD1,320million, TWD1,334 million in the current year, respectively.
In the sensitivity analysis, the prevalence of anti-HCV positive is the most sensitive variables from epidemiology data. The budget impact varied from -TWD 1,287 to -1,204 million when the prevalence of anti-HCV positive varied from 2.1% to 4.4%. Among the cost of treatments, the most sensitive parameter is the average genotype-specific DAAs cost, ranging between -TWD2885 to 338 million.
Conclusions
The results demonstrate that extending coverage to all the patients with direct-acting antivirals is less costly than prioritizing patients with F3 or above fibrosis. The sensitivity analysis shows that the prevalence of anti-HCV positive and the genotype-specific DAAs cost are the sensitive input variables in models.
Table of Contents
Chapter1:Introduction...................................1
1.1.Study Background....................................1
1.2.Statement of the Problem............................4
1.3.Conceptual Framework................................5
1.4.Significance of the Study..........................10
1.5.Study Purpose......................................11
Chapter 2: Review of Literature........................12
2.1.Global Epidemiology of Chronic Hepatitis C.........12
2.2.Taiwan Epidemiology of Chronic Hepatitis C.........15
2.3.The Natural History of Chronic Hepatitis C.........21
2.4.The Stage of Chronic Hepatitis C...................23
2.5.Disease and Economic Burden of Chronic Hepatitis C.25
2.6.Treatment Goal: SVR................................27
2.7.Treatment of Hepatitis C virus.....................29
2.8.Treatment Guidelines for the Treatment of Hepatitis C virus..................................................30
2.9.Taiwan Hepatitis C Policy Guideline(Ministry of Health and Welfare, 2019/05)...........................31
2.10.Efficacy and Safety of Drugs for Hepatitis C virus .......................................................37
2.10.1.SVR in the Pegylated Interferon plus Ribavirin in Taiwan.................................................37
2.10.2.SVR in the Genotype Specific Directly Acting Antiviral Therapy in Taiwan............................40
2.10.3.SVR in the Pan-genotypic Directly Acting Antiviral Therapy................................................42
2.10.4.Adverse events in the Directly Acting Antiviral Therapy in Taiwan......................................45
2.11.Economic Assessments in Healthcare................47
Chapter 3: Methods.....................................52
3.1.Model Overview.....................................52
3.2.Time Horizon.......................................54
3.3.Target Population..................................55
3.4.Payer Perspective..................................59
3.5.Basic Model’s assumptions..........................60
3.6.Drug-Related Cost..................................62
3.7.Sensitivity Analysis...............................64
Chapter 4: Results.....................................67
4.1Target Population and Treatment Costs...............67
4.2Sensitivity Analysis................................82
Chapter 5: Discussion and Conclusion...................85
Supplementary 1........................................89
Bibliographies.........................................96
List of Figures
Figure 1 Analytic framework for a budget scenario(Adapted from Sullivan et al., 2014).............................8
Figure 2 Cost calculator model..........................9
Figure 3 Natural history of hepatitis C (Adapted from S. L. Chen & Morgan, 2006; Hajarizadeh et al., 2013; Lingala & Ghany, 2015; Seeff, 2002)............................22
Figure 4 Budget impact from current year...............82
Figure 5 A one-way sensitivity analysis for variables from epidemiology data.................................84
Figure 6 A one-way sensitivity analysis for average cost from real world data...................................85
List of Tables
Table 1 The key elements of budget impact analysis (Adapted from Sullivan et al., 2014)....................6
Table 2 Estimated prevalence of HCV infection in the general population (Adapted from World Health Organization. Hepatitis C).............................13
Table 3 Global prevalence of hepatitis C virus genotypes (Adapted from Petruzziello et al., 2016)...............14
Table 4 Prevalence of anti-HCV (+) in Taiwan...........17
Table 5 Prevalence stratified by Metavir Fibrosis Stage in Taiwan..............................................18
Table 6 Prevalence of hepatitis C virus genotypes in Taiwan.................................................19
Table 7 Comparison of histologic scoring systems.......24
Table 8 New oral drugs for hepatitis C covered by the National Health Insurance in Taiwan (2019/1/1).........33
Table 9 Summary of SVR rate to peg-interferon plus ribavirin combination therapy for chronic hepatitis C in Taiwan.................................................38
Table 10 SVR to genotype specific direct acting antivirals regimens for chronic hepatitis C in Taiwan .......................................................40
Table 11 SVR12 in all patients treated with glecaprevir + pibrentasvir...........................................43
Table 12Adverse events in the Directly Acting Antiviral Therapy in Taiwan& Japan...............................45
Table 13Summary of the relevant research...............49
Table 14 Baseline values and ranges for the budget impact analysis...............................................57
Table 15 Baseline values and ranges of outpatient-cost per treatment..........................................63
Table 16Values and ranges for the sensitivity analysis.66
Table 17 An estimate of the target population for HCV in Taiwan.................................................70
Table 18 An estimate of the annual population in current scenario...............................................73
Table 19 An estimate of the annual population in new scenario...............................................76
Table 20 An estimate of total cost in current scenario (First priority: G1, F3-4 patients treated with genotype-specific DAAs, and other patients treated with Peg-IFN/RBV)...............................................77
Table 21 An estimate of total cost in new scenario (treat all stages and genotypes with pan-genotypic DAAs)......79
Table 22 Budget impact of pan-genotypic DAAs for the treatment of all stages HCV adult patients from current year...................................................81
Bibliographies
T.F.D.A.(February 12,2018). Drug License :Maviret Film-Coated Tablets 100mg/40mg. Retrieved from https://www.fda.gov.tw/mlms/H0001D.aspx?Type=Lic&LicId=52027323
AASLD‐IDSA. (September 21, 2017). HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Retrieved from https://www.hcvguidelines.org/
Administration, T. U. S. F. a. D. (August 03, 2017). FDA approves Mavyret for Hepatitis C. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-mavyret-hepatitis-c
Armstrong, G. L. (2003). Commentary: Modelling the epidemiology of hepatitis C and its complications. Int J Epidemiol, 32(5), 725-726. doi:10.1093/ije/dyg266
Bedossa, P., & Poynard, T. (1996). An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology, 24(2), 289-293. doi:10.1002/hep.510240201
Bennett, H., Waser, N., Johnston, K., Kao, J. H., Lim, Y. S., Duan, Z. P., . . . Li, H. (2015). A review of the burden of hepatitis C virus infection in China, Japan, South Korea and Taiwan. Hepatol Int, 9(3), 378-390. doi:10.1007/s12072-015-9629-x
Chahal, H. S., Marseille, E. A., Tice, J. A., Pearson, S. D., Ollendorf, D. A., Fox, R. K., & Kahn, J. G. (2016). Cost-effectiveness of Early Treatment of Hepatitis C Virus Genotype 1 by Stage of Liver Fibrosis in a US Treatment-Naive Population. JAMA Intern Med, 176(1), 65-73. doi:10.1001/jamainternmed.2015.6011
Chayama, K., Suzuki, F., Karino, Y., Kawakami, Y., Sato, K., Atarashi, T., . . . Kumada, H. (2018). Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 1 hepatitis C virus infection with and without cirrhosis. J Gastroenterol, 53(4), 557-565. doi:10.1007/s00535-017-1391-5
Chen, C. H., Yang, P. M., Huang, G. T., Lee, H. S., Sung, J. L., & Sheu, J. C. (2007). Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants. J Formos Med Assoc, 106(2), 148-155. doi:10.1016/s0929-6646(09)60231-x
Chen, S. L., & Morgan, T. R. (2006). The natural history of hepatitis C virus (HCV) infection. Int J Med Sci, 3(2), 47-52. doi:10.7150/ijms.3.47
El Khoury, A. C., Wallace, C., Klimack, W. K., & Razavi, H. (2012). Economic burden of hepatitis C-associated diseases: Europe, Asia Pacific, and the Americas. J Med Econ, 15(5), 887-896. doi:10.3111/13696998.2012.681332
Fried, M. W., Shiffman, M. L., Reddy, K. R., Smith, C., Marinos, G., Goncales, F. L., Jr., . . . Yu, J. (2002). Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med, 347(13), 975-982. doi:10.1056/NEJMoa020047
Gane, E. J., Roberts, S. K., Stedman, C. A., Angus, P. W., Ritchie, B., Elston, R., . . . Smith, P. F. (2010). Oral combination therapy with a nucleoside polymerase inhibitor (RG7128) and danoprevir for chronic hepatitis C genotype 1 infection (INFORM-1): a randomised, double-blind, placebo-controlled, dose-escalation trial. Lancet, 376(9751), 1467-1475. doi:10.1016/s0140-6736(10)61384-0
Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. (2017). Lancet Gastroenterol Hepatol, 2(3), 161-176. doi:10.1016/s2468-1253(16)30181-9
Hajarizadeh, B., Grebely, J., & Dore, G. J. (2013). Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol, 10(9), 553-562. doi:10.1038/nrgastro.2013.107
Hong, C. M., Liu, C. H., Su, T. H., Yang, H. C., Chen, P. J., Chen, Y. W., . . . Liu, C. J. (2018). Real-world effectiveness of direct-acting antiviral agents for chronic hepatitis C in Taiwan: Real-world data. J Microbiol Immunol Infect. doi:10.1016/j.jmii.2018.09.005
Ioannou, G. N., Green, P. K., & Berry, K. (2017). HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma. J Hepatol. doi:10.1016/j.jhep.2017.08.030
Ishak, K., Baptista, A., Bianchi, L., Callea, F., De Groote, J., Gudat, F., . . . et al. (1995). Histological grading and staging of chronic hepatitis. J Hepatol, 22(6), 696-699.
Kao, J. H., Chen, P. J., Lai, M. Y., Yang, P. M., Sheu, J. C., Wang, T. H., & Chen, D. S. (1995). Genotypes of hepatitis C virus in Taiwan and the progression of liver disease. J Clin Gastroenterol, 21(3), 233-237.
Kwo, P. Y., Poordad, F., Asatryan, A., Wang, S., Wyles, D. L., Hassanein, T., . . . Mensa, F. J. (2017). Glecaprevir and pibrentasvir yield high response rates in patients with HCV genotype 1-6 without cirrhosis. J Hepatol, 67(2), 263-271. doi:10.1016/j.jhep.2017.03.039
Leidner, A. J., Chesson, H. W., Xu, F., Ward, J. W., Spradling, P. R., & Holmberg, S. D. (2015). Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease. Hepatology, 61(6), 1860-1869. doi:10.1002/hep.27736
Li, X., Chan, N. S., Tam, A. W., Hung, I. F. N., & Chan, E. W. (2017). Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong. Eur J Clin Microbiol Infect Dis, 36(10), 1801-1809. doi:10.1007/s10096-017-2995-7
Liu, C. H., Liu, C. J., Lin, C. L., Liang, C. C., Hsu, S. J., Yang, S. S., . . . Kao, J. H. (2008). Pegylated interferon-alpha-2a plus ribavirin for treatment-naive Asian patients with hepatitis C virus genotype 1 infection: a multicenter, randomized controlled trial. Clin Infect Dis, 47(10), 1260-1269. doi:10.1086/592579
Liu, C. H., Liu, C. J., Su, T. H., Yang, H. C., Hong, C. M., Tseng, T. C., . . . Kao, J. H. (2018). Real-world effectiveness and safety of sofosbuvir and ledipasvir with or without ribavirin for patients with hepatitis C virus genotype 1 infection in Taiwan. PLoS One, 13(12), e0209299. doi:10.1371/journal.pone.0209299
Liu, C. J., Chuang, W. L., Lee, C. M., Yu, M. L., Lu, S. N., Wu, S. S., . . . Chen, D. S. (2009). Peginterferon alfa-2a plus ribavirin for the treatment of dual chronic infection with hepatitis B and C viruses. Gastroenterology, 136(2), 496-504.e493. doi:10.1053/j.gastro.2008.10.049
Manns, M. P., McHutchison, J. G., Gordon, S. C., Rustgi, V. K., Shiffman, M., Reindollar, R., . . . Albrecht, J. K. (2001). Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet, 358(9286), 958-965. doi:10.1016/s0140-6736(01)06102-5
Mauskopf, J. A., Sullivan, S. D., Annemans, L., Caro, J., Mullins, C. D., Nuijten, M., . . . Trueman, P. (2007). Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices--budget impact analysis. Value Health, 10(5), 336-347. doi:10.1111/j.1524-4733.2007.00187.x
McEwan, P., Ward, T., Chen, C. J., Lee, M. H., Yang, H. I., Kim, R., . . . Yuan, Y. (2014). Estimating the Incidence and Prevalence of Chronic Hepatitis C Infection in Taiwan Using Back Projection. Value Health Reg Issues, 3, 5-11. doi:10.1016/j.vhri.2013.08.001
Michael Zoratti, H., Canada. (July 2018). Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection [Internet].Web Annex 3.2. Adult hepatitis C virus treatment
systematic review; supporting evidence. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/277216/WHO-CDS-HIV-18.37-eng.pdf?ua=1
Ministry of Health and Welfare, R. T. 「我國現階段 C 肝篩檢、治療及防治現況」.
Ministry of Health and Welfare, R. T. (2019). Taiwan Hepatitis C Policy Guideline 2018-2025
Ministry of Health and Welfare, R. T. (2019/05). Taiwan Hepatitis C Policy Guideline 2018-2025.
Ng, V., & Saab, S. (2011). Effects of a sustained virologic response on outcomes of patients with chronic hepatitis C. Clin Gastroenterol Hepatol, 9(11), 923-930. doi:10.1016/j.cgh.2011.05.028
Nguyen, L. H., & Nguyen, M. H. (2013). Systematic review: Asian patients with chronic hepatitis C infection. Aliment Pharmacol Ther, 37(10), 921-936. doi:10.1111/apt.12300
Omata, M., Kanda, T., Wei, L., Yu, M. L., Chuang, W. L., Ibrahim, A., . . . Sarin, S. K. (2016). APASL consensus statements and recommendation on treatment of hepatitis C. Hepatol Int, 10(5), 702-726. doi:10.1007/s12072-016-9717-6
Pearlman, B. L., & Traub, N. (2011). Sustained virologic response to antiviral therapy for chronic hepatitis C virus infection: a cure and so much more. Clin Infect Dis, 52(7), 889-900. doi:10.1093/cid/cir076
Petruzziello, A., Marigliano, S., Loquercio, G., Cozzolino, A., & Cacciapuoti, C. (2016). Global epidemiology of hepatitis C virus infection: An up-date of the distribution and circulation of hepatitis C virus genotypes. World J Gastroenterol, 22(34), 7824-7840. doi:10.3748/wjg.v22.i34.7824
Poordad, F., & Dieterich, D. (2012). Treating hepatitis C: current standard of care and emerging direct-acting antiviral agents. J Viral Hepat, 19(7), 449-464. doi:10.1111/j.1365-2893.2012.01617.x
Razavi, H., Elkhoury, A. C., Elbasha, E., Estes, C., Pasini, K., Poynard, T., & Kumar, R. (2013). Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology, 57(6), 2164-2170. doi:10.1002/hep.26218
Ruggeri, M., Coretti, S., Romano, F., Kondili, L. A., Vella, S., & Cicchetti, A. (2018). Economic Evaluation of the Hepatitis C Virus Treatment Extension to Early-Stage Fibrosis Patients: Evidence from the PITER Real-World Cohort. Value Health, 21(7), 783-791. doi:10.1016/j.jval.2017.10.021
Seeff, L. B. (2002). Natural history of chronic hepatitis C. Hepatology, 36(5 Suppl 1), S35-46. doi:10.1053/jhep.2002.36806
Sheu, J. C., Lee, S. H., Wang, J. T., Shih, L. N., Wang, T. H., & Chen, D. S. (1992). Prevalence of anti-HCV and HCV viremia in hemodialysis patients in Taiwan. J Med Virol, 37(2), 108-112.
Sievert, W., Altraif, I., Razavi, H. A., Abdo, A., Ahmed, E. A., Alomair, A., . . . Negro, F. (2011). A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int, 31 Suppl 2, 61-80. doi:10.1111/j.1478-3231.2011.02540.x
Simin, M., Brok, J., Stimac, D., Gluud, C., & Gluud, L. L. (2007). Cochrane systematic review: pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C. Aliment Pharmacol Ther, 25(10), 1153-1162. doi:10.1111/j.1365-2036.2007.03294.x
Smith-Palmer, J., Cerri, K., & Valentine, W. (2015). Achieving sustained virologic response in hepatitis C: a systematic review of the clinical, economic and quality of life benefits. BMC Infect Dis, 15, 19. doi:10.1186/s12879-015-0748-8
Stanaway, J. D., Flaxman, A. D., Naghavi, M., Fitzmaurice, C., Vos, T., Abubakar, I., . . . Cooke, G. S. (2016). The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet, 388(10049), 1081-1088. doi:10.1016/s0140-6736(16)30579-7
Toyoda, H., Chayama, K., Suzuki, F., Sato, K., Atarashi, T., Watanabe, T., . . . Kumada, H. (2018). Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 2 hepatitis C virus infection. Hepatology, 67(2), 505-513. doi:10.1002/hep.29510
Tsai, P. C., Liu, T. W., Tsai, Y. S., Ko, Y. M., Chen, K. Y., Lin, C. C., . . . Yu, M. L. (2017). Identification of groups with poor cost-effectiveness of peginterferon plus ribavirin for naive hepatitis C patients with a real-world cohort and database. Medicine (Baltimore), 96(22), e6984. doi:10.1097/md.0000000000006984
World Health Organization. Hepatitis C. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
Yang, W.-T., Lai, M.-S., & Kao, J.-H. (2016). Utilization Analysis of Anti-HCV Treatment in Taiwanese with Chronic Hepatitis C Using National Health Insurance Research Database. [Utilization Analysis of Anti-HCV Treatment in Taiwanese with Chronic Hepatitis C Using National Health Insurance Research Database]. Formosan Journal of Medicine, 20(2), 124-133. doi:10.6320/fjm.2016.20(2).2
Yu, M. L., Chuang, W. L., Chen, S. C., Dai, C. Y., Hou, C., Wang, J. H., . . . Chang, W. Y. (2001). Changing prevalence of hepatitis C virus genotypes: molecular epidemiology and clinical implications in the hepatitis C virus hyperendemic areas and a tertiary referral center in Taiwan. J Med Virol, 65(1), 58-65.
Yu, M. L., Dai, C. Y., Huang, J. F., Chiu, C. F., Yang, Y. H., Hou, N. J., . . . Chuang, W. L. (2008). Rapid virological response and treatment duration for chronic hepatitis C genotype 1 patients: a randomized trial. Hepatology, 47(6), 1884-1893. doi:10.1002/hep.22319
Yu, M. L., Dai, C. Y., Huang, J. F., Hou, N. J., Lee, L. P., Hsieh, M. Y., . . . Chuang, W. L. (2007). A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C. Gut, 56(4), 553-559. doi:10.1136/gut.2006.102558
Yu, M. L., Huang, C. F., Huang, J. F., Chang, N. C., Yang, J. F., Lin, Z. Y., . . . Chuang, W. L. (2011). Role of interleukin-28B polymorphisms in the treatment of hepatitis C virus genotype 2 infection in Asian patients. Hepatology, 53(1), 7-13. doi:10.1002/hep.23976
Yu, M. L., Yeh, M. L., Tsai, P. C., Huang, C. I., Huang, J. F., Huang, C. F., . . . Chang, W. Y. (2015). Huge gap between clinical efficacy and community effectiveness in the treatment of chronic hepatitis C: a nationwide survey in Taiwan. Medicine (Baltimore), 94(13), e690. doi:10.1097/md.0000000000000690
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