Hi Maz, I too had two DAA treatment options, so difficulty deciding which option I would prefer All the drugs available here are good, so I might as well have flipped a coin to decide. It could have saved a lot of time if I’d gone that route. Instead I read every recent relevant study I could find. One of them that showed a 1% better chance of SVR. Now that 1% in my situation is infinitesimal, but it was the decider. So my advice to you … flip a coin!

Come on in Kathleen, the water’s fine!

Hi Bogdan 16, It was the old Interferon treatments that made people feel too sick to work. We are lucky the DAA drugs are trouble-free, most of us who are on them can play and work as usual throughout treatment.
Best wishes for deciding which treatment will be best to treat your type1. I too found it hard to decide, but you are lucky because you have received good advice from Gaj and Dr James Freeman.

Hello countless, You’re right, it’s always best to check high blood pressure readings further. Many people feel completely unaware when their BP is too high, and that means they do not get access to prevention measures. We all month by month get older, so bad BP can eventually catch up with anyone. On the other hand if you were being monitored in a clinic, it may be wise to monitor yourself at home too just in case you got a high reading purely due to your body’s reaction to the clinical setting.

Available online 25 April 2017, doi:10.1016/j.drugpo.2017.03.015
Research paper
Managing expense and expectation in a treatment revolution: Problematizing prioritisation through an exploration of hepatitis C treatment ‘benefit’

Magdalena Harris
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H9SH, UK
Received 8 November 2016. Revised 8 March 2017. Accepted 22 March 2017. Available online 25 April 2017.
Abstract

Background

Direct-acting antivirals (DAAs) have transformed the hepatitis C (HCV) treatment landscape. These highly effective drugs are, however, not available to all. In a context of DAA rationing, clinicians are advised to “manage patient expectations” about the benefits of a HCV cure. This directive particularly pertains to people with minimal liver damage and those who have ceased injecting: populations negated in contemporary prioritisation debates.

Methods

This paper engages with the assumptions underpinning HCV treatment prioritisation discourses to explore the concept of treatment ‘benefit’ from patient perspectives. Data are from a qualitative longitudinal study exploring treatment transitions and decision-making from 2012–2015. Participants comprised 28 people living with HCV, ten treatment providers and eight stakeholders, based in London, United Kingdom (UK). One hundred hours of clinic observations were conducted at two HCV treatment hospitals. Thematic analyses pertaining to treatment expectation and outcome inform this paper.

Results

Twenty-two participants commenced treatment. The majority who were unable to access DAAs chose to commence interferon-based treatment immediately rather than wait. Participants accounted for treatment urgency in relation to three interrelated narratives of hope and expectation. HCV treatment promised: social reconnection; social redemption and a return to ‘normality’. For many with successful treatment outcomes, these benefits appeared to be realised.

Conclusion

The DAA era heralds a discursive shift: from ‘managing [interferon] risk and difficulty’ to ‘managing [DAA] expense and expectation’. Calls to ‘manage patient expectations’ about the benefits of HCV cure are predicated on clinical benefits only, negating the social impacts of living with HCV. The public health priorities commonly articulated in treatment prioritisation debates are not consistent with those of people managing illness in their daily lives. During this ‘treatment revolution’ there is a need to be cognisant of the multiple publics living with the virus and the treatment needs of those who do not fit population-health scenarios.

Keywords

Hepatitis C
Treatment benefit
Prioritisation
Rationing
Patient expectations
Qualitative research
© 2017 Elsevier B.V. All rights reserved.