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Malaisamy M, Nagarajan K, Kirti T, Malkeet S, Venkatesan P, Senthilkumar S, Sananthya K, Rajendran K, Kavitha R, Vivekanandan S, Selvavinayagam TS. Economic Evaluation of Implementing a Rapid Point-of-Care Screening Test for the Identification of Hepatitis C Virus under National Viral Hepatitis Control Programme in Tamil Nadu, South India. J Glob Infect Dis 2021; 13:126-132. [PMID: 34703152 PMCID: PMC8491813 DOI: 10.4103/jgid.jgid_394_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/27/2020] [Accepted: 01/30/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis. Methods: To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy. Conclusions: The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.
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Affiliation(s)
- Muniyandi Malaisamy
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karikalan Nagarajan
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Tyagi Kirti
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Singh Malkeet
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Prakash Venkatesan
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - S Senthilkumar
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karthikeyan Sananthya
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Krishnan Rajendran
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Rajsekar Kavitha
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - T S Selvavinayagam
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
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Bloom DE, Khoury A, Srinivasan V. Estimating the net value of treating hepatitis C virus using sofosbuvir-velpatasvir in India. PLoS One 2021; 16:e0252764. [PMID: 34292958 PMCID: PMC8297876 DOI: 10.1371/journal.pone.0252764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Recently developed direct-acting antiviral (DAA) treatments for hepatitis C virus (HCV) have been groundbreaking for their high efficacy across disease genotypes and lack of severe side effects. This study uses a cost-of-illness (COI) approach to estimate the net value conferred by this class of drugs using the cost and efficacy of one of these novel drug combinations, sofosbuvir and velpatasvir (SOF/VEL), recently licensed for generic manufacture in India. This study considers COI of lifetime earnings lost by patients and potential secondarily infected individuals due to disability and premature death from HCV infection. Expected net benefits of treatment are substantial for non-cirrhotic (NC) and compensated cirrhotic (CC) patients (ranging from 5,98,003 INR for NC women to 1,05,25,504 INR for CC men). Increased earnings are not sufficient to fully offset cost of treatment for decompensated cirrhotic individuals but treatment may still be justified on the basis of the intrinsic value of health improvements and other treatment benefits.
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Affiliation(s)
- David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Alexander Khoury
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - V. Srinivasan
- Stanford Graduate School of Business, Stanford, California, United States of America
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Papic N, Radmanic L, Dusek D, Kurelac I, Zidovec Lepej S, Vince A. Trends of Late Presentation to Care in Patients with Chronic Hepatitis C during a 10-Year Period in Croatia. Infect Dis Rep 2020; 12:74-81. [PMID: 33187150 PMCID: PMC7768519 DOI: 10.3390/idr12030016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Late presentation to care is the major obstacle to receiving treatment for chronic hepatitis C (CHC). Our aim was to analyze the prevalence and trends of late presenters (LP) at first consultations in Croatia during a 10-year period. This retrospective cross-sectional study included all adult CHC patients (n = 854) entering specialist medical care at the University Hospital for Infectious Diseases Zagreb between 2009 and 2018. LP was defined as liver stiffness measurement ≥ 9.5 kPa or biopsy METAVIR F ≥ 3. During the study period, mean patients' age increased from 37 to 52 years while HCV genotype distribution changed leading to the replacement of genotype 1b with 1a (g1b 32% to 21%; g1a 19% to 38%). A total of 320 (37.4%) were LP; they were older (47.5, IQR 40.5-57.6), and more commonly infected with g1b (34.1%) and g3 (42.5%). The prevalence of LP significantly increased from 31.9% in 2009 to 46.5% in 2018. Late presentation for care of CHC is increasing in Croatia suggesting a gap of diagnosing strategies in patients over 50 years.
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Affiliation(s)
- Neven Papic
- Department of Viral Hepatitis, University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia; (N.P.); (D.D.); (I.K.); (A.V.)
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Leona Radmanic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia;
| | - Davorka Dusek
- Department of Viral Hepatitis, University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia; (N.P.); (D.D.); (I.K.); (A.V.)
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Ivan Kurelac
- Department of Viral Hepatitis, University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia; (N.P.); (D.D.); (I.K.); (A.V.)
| | - Snjezana Zidovec Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia;
| | - Adriana Vince
- Department of Viral Hepatitis, University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia; (N.P.); (D.D.); (I.K.); (A.V.)
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
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Sood AK, Manrai M, Thareja S, Shukla R, Patel A. Epidemiology of hepatitis C virus infection in a tertiary care hospital. Med J Armed Forces India 2020; 76:443-450. [PMID: 33162654 PMCID: PMC7606104 DOI: 10.1016/j.mjafi.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are epidemiological lacunae in literature of hepatitis C virus (HCV) infection. We report a prospective observational study of asymptomatic HCV infected patients from a tertiary care Government Hospital. METHODS All consecutive asymptomatic antibodies to hepatitis C virus (anti-HCV) positive patients were studied from July 2011 to April 2016. Patients were reviewed for demographic factors including symptom profile, risk factors, family screening, and point prevalence in relation to various districts of Punjab and Haryana. RESULTS One thousand twelve patients were studied with median age of 52 years (range:13-85) with a male to female ratio of 0.87. Eight hundred (79.25%) patients were from Punjab and 110 (10.67%) from Haryana. Forty percent patients were in 40-60 age group. Six hundred seventy patients (66.21%) did not have any apparent risk factor, 274 (27.08%) had one risk factor, and 68 patients (6.72%) had > 2 risk factors. Commonest risk factor was h/o surgery in 243 patients (24.01%), 32 patients had h/o IV drug abuse and 29 among them were < 30 years. Three hundred and sixty-seven families and children were screened, and 27 spouses and 16 children were found to be anti-HCV positive. The risk factor of IV drug abuse was more common in the younger adults with age ≤ 30 years as compared with age > 30 years (p = 0.001). CONCLUSION HCV infection was common in certain districts of Punjab and common in adults of 40-60 years. This finding needs to be confirmed in larger population-based study. The IV drug abuse is the risk factor of concern among young adults.
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Affiliation(s)
| | - Manish Manrai
- Associate Professor, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | | | - Rajat Shukla
- Commandant, Military Hospital Namkum, Ranchi, Jharkhand, India
| | - Amol Patel
- Classified Specialist (Medicine) & Medical Oncologist, Army Hospital (R&R), New Delhi-110010, India
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Vyas BH, Darji NH, Rana DA, Vyas KY, Malhotra SD. Impact of newer direct-acting antiviral drugs based on quality-adjusted life years: A prospective pharmacoeconomic study in hepatitis C patients. Perspect Clin Res 2020; 12:76-82. [PMID: 34012903 PMCID: PMC8112329 DOI: 10.4103/picr.picr_123_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 11/04/2022] Open
Abstract
Context The Indian government is dispensing newer direct-acting antiviral (DAA) drugs, which may have impact on hepatitis C virus (HCV) patients' quality of life (QoL). Aims To evaluate different DAA regimens and impact on QoL in terms of quality-adjusted life year (QALY) in HCV patients and to measure cost-effectiveness. Methods This prospective, observational study was carried out on patients who were diagnosed with HCV. Recruited patients were followed up until 12-24 weeks. Patients were recruited following the selection criteria. Along with demographic and drug details, the regimens used were analyzed and evaluated for cost minimization, cost-effectiveness, and cost-utility analysis. For health quality check, the Chronic Liver Disease questionnaire (CLDQ) was used which was also used for QALY assessment. Data were entered into MS Excel 2016. Difference in between the regimens for total cost was done using unpaired t-test and ANOVA test using SPSS 25.0. Overall cost-effectiveness, cost minimization, cost utility and cost of illness analysis was also calculated. P < 0.05 was considered statistically significant. Results A total of 31 patients were enrolled. A total of five drugs, namely, sofosbuvir, daclatasvir, ribavirin, velpatasvir, and ledipasvir were widely used. Sofosbuvir was most common (46.25%)component of drug combination in our study. A total of five types of regimen were used according to the genotype of patients. With 44,260.13 ± 15,884.92 INR of the total drug cost, 70.97% of patients spent around 30,000-40,000 INR for the whole pharmacotherapy. The total indirect cost was 2768.39 ± 3916.13 INR with the total direct cost of 48,660.90 ± 15,356.39 INR. The total cost including direct as well as indirect cost spent during 6-month therapy by 61.29% of patients was 40,000-50,000 INR. Based on the CLDQ score, QoL was 64.1 ± 25. Regimen 2 (sofosbuvir + velpatasavir) stood out with the lowest cost. Regimen 5 (ribavirin [200 mg] + sofosbuvir [400 mg] + velpatasvir [100 mg]) was found to be the most cost-effective. Considering 1 life year with good health after treatment, QALY was 0.31. Conclusions Ribavirin (200 mg) + sofosbuvir (400 mg) + velpatasvir (100 mg) was found to be the cost-effective and cost-saving regimen among DAAs.
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Affiliation(s)
- Bhavya H Vyas
- Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Nishita H Darji
- Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Devang A Rana
- Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Kaushal Y Vyas
- Department of Gastroenterology, Seth V.S. Hospital, Ahmedabad, Gujarat, India
| | - Supriya D Malhotra
- Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Sinha MK, Raghuwanshi B, Mishra B. Menace of Hepatitis C virus among multitransfused thalassemia patients in Balasore district of Odisha state in India. J Family Med Prim Care 2019; 8:2850-2854. [PMID: 31681654 PMCID: PMC6820385 DOI: 10.4103/jfmpc.jfmpc_449_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/19/2019] [Accepted: 07/12/2019] [Indexed: 02/01/2023] Open
Abstract
CONTEXT Hepatitis C virus (HCV) is a potential cause of morbidity and mortality worldwide. It is most commonly transmitted through injecting drug use; the reuse or inadequate sterilization of medical equipment and the transfusion of unscreened blood products. Management of thalassemia requires long-term blood transfusion. Though it improves the overall survival, it carries a definite risk of infection which is expected to be higher in resource limited settings. AIMS To find the percentage of transfusion-transmitted infections (TTIs) in multitransfused patients of thalassemia in Eastern India. SETTINGS AND DESIGN The study was conducted to assess blood safety in rural population in India by measuring the percentage of TTIs including HCV in multitransfused thalassemia patients. METHODS AND MATERIALS One hundred and twenty three patients with major beta-thalassemia were enrolled in this study. The blood samples were tested using ELISA technique for all TTIs. HIV fourth generation kits, HbsAg, HCV third generation kits, malaria and syphilis, parbovirus IgM and parbovirus IgG kits, HEV Antigen and IgM antibody were used. STATISTICAL ANALYSIS USED Proportions and means were calculated for categorical and continuous variables, respectively. Chi-square test was applied and P value of <0.05 was taken as significant. RESULTS The mean age of patients was 9.5 years ± 5.2 years. Among various TTIs, Hepatitis C and HIV was prevalent among 59.3% and 4.1% of the study participants, respectively. CONCLUSIONS The causes of high prevalence of HCV may be due to donors being usually asymptomatic in early stages, despite being screened for HCV possibly due to missing early window period infections. The screening methodology of TTIs particularly HCV at the district and village level and consequent increased prevalence of HCV in multitransfused rustic population of India shows the extent of blood safety.
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Affiliation(s)
- Mithilesh K. Sinha
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Babita Raghuwanshi
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bijayanimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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Tmu N, Kumar A, Sharma P, Singla V, Bansal N, Arora A. Results of Sofosbuvir Plus Ribavirin in Patients With Hepatitis C Related Decompensated Cirrhosis. J Clin Exp Hepatol 2019; 9:4-12. [PMID: 30765933 PMCID: PMC6363947 DOI: 10.1016/j.jceh.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sofosbuvir (SOF), a direct acting antiviral, has revolutionized the treatment of chronic Hepatitis C Virus (HCV) infection. However, data is scarce about efficacy of SOF plus Ribavarin (RBV) in Indian patients with decompensated cirrhosis. We evaluated the efficacy of SOF plus RBV in decompensated cirrhosis, and compared the outcome with compensated cirrhosis and non-cirrhotics. PATIENTS AND METHODS Consecutive decompensated cirrhotic patients of chronic HCV with detectable HCV RNA were treated with 24-week course of SOF (400 mg) plus weight based RBV. Sustained Virological Response (SVR), Child Turcotte Pugh (CTP) and Model for Endstage Liver Disease (MELD) scores were assessed at 36 weeks (i.e. 12 weeks after completion of therapy). Non-cirrhotic chronic hepatitis C patients and patients with compensated cirrhosis treated with SOF plus RBV during the same period were used as controls. During the period of this study ledipasvir and daclatasvir were not available in India. RESULTS A total of 47 patients [median age 50 (29-82) years, 64% males] with decompensated cirrhosis were included as 'cases' in the study; while, 27 patients with compensated cirrhosis and 29 patients with chronic hepatitis were included as 'controls'. Age, gender, HCV RNA levels, and genotype distribution were similar in cases and controls. The median CTP and MELD scores of cases were 8 (7-12) and 13 (6-25), respectively. Among cases 39 (83%) could complete the therapy, while 1 (2%) was intolerant and 7 (15%) died before completion of therapy. End of Treatment Response (ETR) was achieved in 37/39 (95%) cases. Of these, another 3 died before SVR, and 7 failed to achieve SVR, thus 27/34 (79%) could achieve SVR. Thus according to intention-to-treat analysis, only 27/47 (57%) cases could achieve SVR. In comparison, 24/28 (86%) compensated cirrhotics and 27/28 (96%) of chronic hepatitis achieved SVR. There was a significant improvement in mean CTP score in cases who achieved SVR (P < 0.01) compared to those who did not achieve SVR/ETR. On multivariate analysis the only independent factor influencing successful outcome patients was a serum albumin >3.5 g/dL. CONCLUSIONS A 24-week course of SOF plus ribavirin in decompensated HCV cirrhosis could lead to SVR in only 57% of patients. The failure of therapy in 43% patients was either due to non-response, intolerance, or death. A serum albumin of more than 3.5 is associated with success of antiviral therapy. Thus an early initiation of antiviral therapy is recommended before decompensation sets in as it precludes successful outcome.
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Key Words
- CBC, Complete Blood Count
- CHC, Chronic Hepatitis C
- CTP, Child Turcotte Pugh
- DAA, Direct-Acting Antivirals
- ETR, End of Treatment Response
- GFR, Glomerular Filtration Rate
- HBV, Hepatitis B Virus
- HBsAg, Hepatitis B Surface Antigen
- HCC, Hepatocellular Carcinoma
- HCV
- HCV, Hepatitis C Virus
- HIV, Human Immunodeficiency Virus
- LFT, Liver Function Test
- MELD, Model for Endstage Liver Disease
- PegIFN, Pegylated Interferon
- RFT, Renal Function Test
- RNA, Ribo-nucleic Acid
- RVR, Rapid Virological Response
- SOF, Sofosbuvir
- SVR, Sustained Virological Response
- UGI, Upper Gastro-intestinal
- USG, Ultrasonography
- ascites
- decompensated cirrhosis
- direct acting antivirals
- sofosbuvir
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Affiliation(s)
| | | | | | | | | | - Anil Arora
- Institute of Liver, Gastroenterology, & Panceatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Nguyen P, Vutien P, Hoang J, Trinh S, Le A, Yasukawa LA, Weber S, Henry L, Nguyen MH. Barriers to care for chronic hepatitis C in the direct-acting antiviral era: a single-centre experience. BMJ Open Gastroenterol 2017; 4:e000181. [PMID: 29333275 PMCID: PMC5759739 DOI: 10.1136/bmjgast-2017-000181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 01/06/2023] Open
Abstract
Background Cure rates for chronic hepatitis C have improved dramatically with direct-acting antivirals (DAAs), but treatment barriers remain. We aimed to compare treatment initiation rates and barriers across both interferon-based and DAA-based eras. Methods We conducted a retrospective cohort study of all patients with chronic hepatitis C seen at an academic hepatology clinic from 1999 to 2016. Patients were identified to have chronic hepatitis C by the International Classification of Diseases, Ninth Revision codes, and the diagnosis was validated by chart review. Patients were excluded if they did not have at least one visit in hepatology clinic, were under 18 years old or had prior treatment with DAA therapy. Patients were placed in the DAA group if they were seen after 1 January 2014 and had not yet achieved virological cure with prior treatment. All others were considered in the interferon group. Results 3202 patients were included (interferon era: n=2688; DAA era: n=514). Despite higher rates of decompensated cirrhosis and medical comorbidities in the DAA era, treatment and sustained virological response rates increased significantly when compared with the interferon era (76.7% vs 22.3%, P<0.001; 88.8% vs 55%, P<0.001, respectively). Lack of follow-up remained a significant reason for non-treatment in both groups (DAA era=24% and interferon era=45%). An additional 8% of patients in the DAA era were not treated due to insurance or issues with cost. In the DAA era, African-Americans, compared with Caucasians, had significantly lower odds of being treated (OR=0.37, P=0.02). Conclusions Despite higher rates of medical comorbidities in the DAA era, considerable treatment challenges remain including cost, loss to follow-up and ethnic disparities.
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Affiliation(s)
- Peter Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA.,School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Philip Vutien
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Joseph Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Sam Trinh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - An Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Lee Ann Yasukawa
- Center for Clinical Informatics, Stanford School of Medicine, Palo Alto, California, USA
| | - Susan Weber
- Center for Clinical Informatics, Stanford School of Medicine, Palo Alto, California, USA
| | - Linda Henry
- Pharmaceutical Outcomes and of Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
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Vutien P, Jin M, Le MH, Nguyen P, Trinh S, Huang JF, Yu ML, Chuang WL, Nguyen MH. Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis. PLoS One 2017; 12:e0183851. [PMID: 28877190 PMCID: PMC5587234 DOI: 10.1371/journal.pone.0183851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/12/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Treatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C. METHODS We conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity. RESULTS We included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1-30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04), region (Europe vs. North America p = 0.004), and data source (clinical chart review vs. administrative database, p = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care. CONCLUSIONS Only one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.
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Affiliation(s)
- Philip Vutien
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
- Rush University Medical Center, Chicago, Illinois, United States of America
| | - Michelle Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Michael H. Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Pauline Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Sam Trinh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Jee-Fu Huang
- Hepatobiliary Section, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Section, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Section, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
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Gupta V, Kumar A, Sharma P, Arora A. Newer direct-acting antivirals for hepatitis C virus infection: Perspectives for India. Indian J Med Res 2017; 146:23-33. [PMID: 29168457 PMCID: PMC5719604 DOI: 10.4103/ijmr.ijmr_679_15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Indexed: 12/20/2022] Open
Abstract
Approximately three per cent of the world's population (170-200 million people) is chronically infected with hepatitis C virus (HCV) and almost 500,000 people die each year (mostly in lower middle-income countries) from complications secondary to HCV infection. In India, HCV infection imposes a considerable burden of mortality, morbidity and healthcare costs. In the last two decades, the treatment of HCV has evolved from interferon (IFN)-based therapies with or without ribavirin (RBV) to pegylated-IFN (PEG-IFN) and RBV-based therapies that were better tolerated by patients. However, the introduction of oral drugs, which specifically target virus-specific proteins, has now revolutionized the treatment of chronic HCV. These agents are known as direct-acting antivirals (DAAs). These drugs have resulted in very high HCV cure rates even with reduced treatment duration and an excellent tolerability by the patients compared to PEG-IFN- and RBV-based therapies. In India, sofosbuvir (SOF), one of the most effective DAAs, has been made available at a compassionate price; thus only those DAA-based management strategies, which contain SOF are adopted in India. Here, we review different DAAs and their possible roles in different genotypes and stages of liver disease, stressing upon the role of SOF. An attempt has also been made to devise strategies using SOF for the most prevalent genotypes in our country (genotypes 3 and 1) and cirrhosis.
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Affiliation(s)
- Varun Gupta
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Anand AC. Potential Liver Transplant Recipients with Hepatitis C: Should They Be Treated Before or After Transplantation? J Clin Exp Hepatol 2017; 7:42-54. [PMID: 28348470 PMCID: PMC5357718 DOI: 10.1016/j.jceh.2017.01.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 12/12/2022] Open
Abstract
Treatment of hepatitis C virus (HCV) with newer directly acting antivirals (DAAs) and lead to sustained viral response (SVR) in majority of patients and SVR has been documented to be associated with reversal of liver cirrhosis. The improved SVR rates and safety profiles of DAAs have led to the treatment of patients with decompensated cirrhosis awaiting liver transplantation (LT). Several clinical trials of DAAs in decompensated HCV patients have recently demonstrated SVR rates above 80%, which have been associated with significant improvements, in the Child-Pugh-Turcotte scores/or model for end-stage liver disease scores in a proportion of patients. Moreover, it has been shown that HCV RNA becomes negative after 2-4 weeks of treatment, and those who are transplanted after becoming HCV RNA negative will be have very low the risk of HCV recurrence after transplantation. Some of the patients may have reached the "point of no return" and may proceed to worsening of decomposition over time. To avoid the risk of worsening, there is an additional option of treating these patients after LT should they develop recurrent HCV infection. Currently there are no guidelines as to select patients who would benefit from treatment prior to LT as opposed to those who will be better off being treated after the transplant surgery. The article discusses a possible approach for such selection.
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Key Words
- CSA, cyclosporine A
- CTP, Child–Turcotte–Pugh staging
- DAA, directly acting antivirals
- DCV, daclatasvir
- DDLT, deceased donor liver transplant
- DSB, dasabuvir
- EBV, elbasvir
- FCH, fibrosing cholestatic hepatitis
- GRZ, grazoprevir
- GT, genotype
- HCV, hepatitis C virus
- IU, international units
- LDLT, living donor liver transplant
- LDV, ledipasvir
- LT, liver transplantation
- MELD, model for end-stage liver disease RNA
- OMB, ombitasvir
- PTV, paritaprevir
- Peg-IFN, pegylated interferon alfa
- RBV, ribavirin
- SMV, simeprevir
- SOF, sofosbuvir
- SVR, sustained virological response, (SVR 12 signifies SVR at 12 weeks)
- TAC, tacrolimus
- VLP, velpatasvir
- decompensated cirrhosis
- directly acting antivirals
- hepatitis C virus infection
- liver transplantation
- rt, ritonavir
- sustained virological response
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Affiliation(s)
- Anil C. Anand
- Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
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