HCV Therapy Selector

Why use the HCV Therapy Selector?
The HCV Therapy Selector is uniquely handy and complete source of information intended for the physician and his patient with hepatitis C to select the best fitting treatment.
Guideline recommendations indicate which therapies according to experts are eligible for a particular patient profile.
The HCV Therapy Selector provides patient profile specific information about the likelihood of cure of hepatitis C infection for all published treatment regimens, and treatment-specific information about side effects, costs and reimbursement. The cure rates are based on 'evidence-based’ data and advanced statistical processing.
The HCV Therapy Selector is developed by the completely independent LiverDoc organisation, in collaboration with Erasmus Medical Center Rotterdam, the Netherlands Association for the Study of the Liver (NASL), and ExpertDoc.
LiverDoc and ExpertDoc make clinical decision support products to bring unbiased academic knowledge to the busy physician and informed choice to the patient.
Funding of the HCV Therapy Selector has come from LiverDoc’s own resources without contributions of the pharmaceutical industry.
Patient-profile specific knowledge from 3 (inter)national guidelines comprising more than 300 pages and more than 125 publications of antiviral therapy hepatitis C can be assessed within 1 minute; all information is updated each quarter.

How is the HCV Therapy Selector constructed?
HCV Therapy Selector connects patient profiles, published treatment combinations and clinical study results.

Patient profiles for chronic HCV infection are based on characteristics crucial for treatment decision making: HCV genotype 1-6, stage of cirrhosis (no/Child A/Child B-C), previous treatment exposure (no/(peg)interferon/sofosbuvir), thereby creating 54 patient profiles in the chronic mono- & co-infection group. Special subgroups like HIV co-infection, HBV co-infection, liver transplant, renal failure in addition can be selected.
Patient profiles for acute HCV infection are based on HCV genotype 1-6.
Published treatment combinations concern all published treatment combinations based on 12 drugs approved by the FDA and European Medicines Agency.
Study results (cure of infection: HCV RNA not detectable 12-24 weeks after stopping antiviral therapy=SVR) were obtained from published preregistration clinical trials as well as prospective real-life postregistration studies with at least 8 patients with a specific treatment regimen.
From each publication, data (total number of patients treated and SVR evaluable, and number of patients with SVR) were extracted per patient profile. Regularly supplementary data had to be obtained. After an internal and external check the data were entered into a certified SQL database.
All data of more than 29000 patients were used in a meta-analysis (Metafor package in R) to estimate the SVR percentages and its 95% predictive interval for each specific combination of patient profile – therapy regimen.
Quality of evidence was graded according to a simple system: ‘high’ (at least 80 patients, data from two or more studies), ‘moderate’ (at least 40 patients or 80 patient data from one study) and ‘low’ (less than 40 patients).
Adverse effects are shown if such effects are clinically relevant by its severity or by a higher frequency than in placebo-controlled trials. This restrictive way of information intends to increase its clarity and may reduce the nocebo effect of comprehensive information.

Costs and reimbursement information are derived from robust sources like www.hepatitisc.uw.edu (USA), Journal Officiel de la République Française (FR), www.riziv.fgov.be (BE) www.g-ba.de and www.medicijnkosten.nl (NL).