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Cheng Q, Valerio H, Cunningham EB, Shih STF, Silk D, Conway A, Treloar C, Murray C, Henderson C, Amin J, Read P, Dore GJ, Grebely J. Health-Related Quality of Life of People Who Inject Drugs: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:216-225. [PMID: 37951538 DOI: 10.1016/j.jval.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/11/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort of PWID in Australia. METHODS Participants were enrolled in an observational cohort study (the Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study) from May 2018 to September 2019 (wave 1) and November 2019 to June 2021 (wave 2). Participants completed the EQ-5D-5L survey at enrolment. Two-part models were used to assess the association of clinical and socioeconomic characteristics with EQ-5D-5L scores. RESULTS Among 2395 participants (median age, 43 years; 66% male), 65% reported injecting drug use in the past month, 20% had current hepatitis C virus (HCV) infection, and 68% had no/mild liver fibrosis (F0/F1). Overall, the mean EQ-5D-5L and EQ-visual analog scale scores were 0.78 and 57, respectively. In adjusted analysis, factors associated with significantly lower EQ-5D-5L scores include older ages, female (marginal effect = -0.03, P = .014), being homeless (marginal effect = -0.04, P = .040), and polysubstance use (marginal effect = -0.05, P < .001). Factors associated with significantly higher EQ-5D-5L scores were being Aboriginal/Torres Strait Islander (marginal effect = 0.03, P = .021) and recent injecting drug use in the past 12 months. Current HCV infection and liver fibrosis stage were not associated with reduced HRQoL among the study participants. CONCLUSIONS PWID experienced a lower HRQoL compared with the general population. Further research is needed to understand HRQoL in this population to facilitate the development of multifaceted care models for PWID beyond HCV cure and inform health economic analyses for identifying optimal health strategies for PWID.
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Affiliation(s)
- Qinglu Cheng
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Heather Valerio
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophy T F Shih
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - David Silk
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anna Conway
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carolyn Murray
- Population Health Strategy and Performance, NSW Health, St Leonards, NSW, Australia
| | | | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Kim SH, Park SH, Lee H. Machine learning for predicting hepatitis B or C virus infection in diabetic patients. Sci Rep 2023; 13:21518. [PMID: 38057379 PMCID: PMC10700585 DOI: 10.1038/s41598-023-49046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Highly prevalent hepatitis B and hepatitis C virus (HBV and HCV) infections have been reported among individuals with diabetes. Given the frequently asymptomatic nature of hepatitis and the challenges associated with screening in some vulnerable populations such as diabetes patients, we conducted an investigation into the performance of various machine learning models for the identification of hepatitis in diabetic patients while also evaluating the significance of features. Analyzing NHANES data from 2013 to 2018, machine learning models were evaluated; random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO) along with stacked ensemble model. We performed hyperparameter tuning to improve the performance of the model, and selected important predictors using the best performance model. LASSO showed the highest predictive performance (AUC-ROC = 0.810) rather than other models. Illicit drug use, poverty, and race were highly ranked as predictive factors for developing hepatitis in diabetes patients. Our study demonstrated that a machine-learning-based model performed optimally in the detection of hepatitis among diabetes patients, achieving high performance. Furthermore, models and predictors evaluated from the current study, we expect, could be supportive information for developing screening or treatment methods for hepatitis care in diabetes patients.
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Affiliation(s)
- Sun-Hwa Kim
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan, Republic of Korea
| | - So-Hyeon Park
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan, Republic of Korea
| | - Heeyoung Lee
- College of Pharmacy, Inje University, Gimhae, Republic of Korea.
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Cheng Q, Bajis S, Cunningham E, Shih STF, Schulz M, Marshall AD, Martin NK, Miners A, Hajarizadeh B, Wiseman V, Dore GJ, Grebely J. Health-related quality of life among people who inject drugs in Australia. Qual Life Res 2023; 32:3195-3207. [PMID: 37351701 PMCID: PMC10522523 DOI: 10.1007/s11136-023-03465-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We aimed to evaluate factors associated with HRQoL among a cohort of PWID in Australia. METHODS Participants were enrolled in an observational cohort study (the LiveRLife Study) between 2014 and 2018 at 15 sites in Australia. They provided fingerstick whole-blood samples for point-of-care HCV RNA testing and underwent transient elastography to assess liver disease. Participants completed the EQ-5D-3L survey at enrolment. Regression models were used to assess the impact of clinical and socioeconomic characteristics on the EQ-5D-3L scores. RESULTS Among 751 participants (median age, 43 years; 67% male), 63% reported injection drug use in the past month, 43% had current HCV infection, and 68% had no/mild liver fibrosis (F0/F1). The mean EQ-5D-3L and EQ-VAS scores were 0.67 and 62, respectively, for the overall study population. There was no significant difference in the EQ-5D-3L scores among people with and without recent injecting drug use (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.78, P = 0.405), and among people receiving and not receiving opioid agonist therapy (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.76, P = 0.215). Participants who were employed were found to have the highest mean EQ-5D-3L (0.83) and EQ-VAS scores (77). The presence of current HCV infection, liver fibrosis stage, and high-risk alcohol consumption had little impact on HRQoL. CONCLUSIONS The study findings provide important HRQoL data for economic evaluations, useful for guiding the allocation of resources for HCV elimination strategies and interventions among PWID.
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Affiliation(s)
- Qinglu Cheng
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Evan Cunningham
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Sophy T F Shih
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Marcel Schulz
- St Vincent's Clinical School, UNSW Medicine, Sydney, NSW, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Virginia Wiseman
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Kensington, Sydney, NSW, 2052, Australia
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Rowe IA. Understanding the risks and benefits of policy action in NAFLD. J Hepatol 2023; 79:22-24. [PMID: 37023965 DOI: 10.1016/j.jhep.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Ian A Rowe
- Leeds Institute for Data Analytics, St. James's University Hospital, University of Leeds, Leeds, United Kingdom.
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McDonald SA, Myring G, Palmateer NE, McAuley A, Beer L, Dillon JF, Hollingworth W, Gunson R, Hickman M, Hutchinson SJ. Improved health-related quality of life after hepatitis C viraemic clearance among people who inject drugs may not be durable. Addiction 2023. [PMID: 36808787 DOI: 10.1111/add.16169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND AIMS Chronic infection with the hepatitis C virus (HCV) has a detrimental impact on health-related quality of life (QoL). Scale-up of HCV direct-acting antiviral (DAA) therapy among people who inject drugs (PWID) is underway in several countries since the introduction of interferon-free regimens. This study aimed to assess the impact of DAA treatment success on QoL for PWID. DESIGN Cross-sectional study using two rounds of the Needle Exchange Surveillance Initiative, a national anonymous bio-behavioural survey and a longitudinal study involving PWID who underwent DAA therapy. SETTING The setting for the cross-sectional study was Scotland (2017-2018, 2019-2020). The setting for the longitudinal study was the Tayside region of Scotland (2019-2021). PARTICIPANTS In the cross-sectional study PWID were recruited from services providing injecting equipment (n = 4009). In the longitudinal study, participants were PWID on DAA therapy (n = 83). MEASUREMENTS In the cross-sectional study, the association between QoL (measured using the EQ-5D-5L quality of life instrument) and HCV diagnosis and treatment was assessed using multilevel linear regression. In the longitudinal study, QoL was compared at four timepoints using multilevel regression, from treatment commencement until 12 months following commencement. FINDINGS In the cross-sectional study, 41% (n = 1618) were ever chronically HCV infected, of whom 78% (n = 1262) were aware of their status and of whom 64% (n = 704) had undergone DAA therapy. There was no evidence for a marked QoL improvement associated with viral clearance among those treated for HCV (B = 0.03; 95% CI, -0.03 to 0.09). In the longitudinal study, improved QoL was observed at the sustained virologic response test timepoint (B = 0.18; 95% CI, 0.10-0.27), but this was not maintained at 12 months following start of treatment (B = 0.02; 95% CI, -0.05 to 0.10). CONCLUSIONS Successful direct-acting antiviral therapy for hepatitis C infection may not lead to a durable improvement in quality of life among people who inject drugs, although there may be a transient improvement around the time of sustained virologic response. Economic models of the impact of scaling-up treatment may need to include more conservative quality of life benefits over and above reductions in mortality, disease progression and transmission of infection.
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Affiliation(s)
- Scott A McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.,Public Health Scotland, Meridian Court, Glasgow, G2 6QE, UK
| | | | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.,Public Health Scotland, Meridian Court, Glasgow, G2 6QE, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.,Public Health Scotland, Meridian Court, Glasgow, G2 6QE, UK
| | | | | | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.,Public Health Scotland, Meridian Court, Glasgow, G2 6QE, UK
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6
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Kåberg M, Larsson S, Bergström J, Hammarberg A. Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden. Qual Life Res 2023; 32:197-207. [PMID: 35996040 PMCID: PMC9829569 DOI: 10.1007/s11136-022-03209-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Needle syringe programs (NSP) significantly reduce risk behavior and HIV and hepatitis transmission in people who inject drugs (PWID). However, PWID are underrepresented in studies on health-related quality of life (HRQoL), representing a barrier to evaluate effects of public health and preventive measures related to injecting drug use. In this study, we investigate how well the two questionnaires EQ-5D-3L and SF-6D measure health in PWID. We also estimate HRQoL in the PWID population. METHOD Data on demographics, injection drug use, HIV, hepatitis status, and self-reported HRQoL were collected from 550 PWID enrolled in the Stockholm NSP at enrollment and at 6-, 12-, and 24-month follow-up. Self-rated HRQoL was measured as QALY, using EQ-5D-3L and the SF-6D. Item response theory (IRT) was used to evaluate which of the two instruments that measure health most accurately in this population. Regression analysis was used to estimate population-specific QALYs. RESULTS The IRT analysis showed that SF-6D was better suited to measure health in PWID. More specifically, SF-6D to a larger extent discriminated between persons regardless of their health status, while EQ-5D was more suitable to detect persons with poorer health. Self-rated HRQoL showed that average QALY was lower among PWID compared to the general Swedish population. However, a general increase in self-reported health was noted over time among participants. CONCLUSION This study increase knowledge of what instruments are most suitable to measure health among PWID. This is of great importance when evaluating effects of public health and preventive measures in the PWID population.
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Affiliation(s)
- Martin Kåberg
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden ,Stockholm Centre for Dependency Disorders, Stockholm Needle Exchange, Stockholm, Sweden
| | - Sofie Larsson
- grid.419734.c0000 0000 9580 3113Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Jakob Bergström
- grid.419734.c0000 0000 9580 3113Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Anders Hammarberg
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Sælør KT, Carlsen SEL, Fadnes LT, Lorås L. Experiences of Hope after Treatment of Hepatitis C Infection-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15732. [PMID: 36497807 PMCID: PMC9738947 DOI: 10.3390/ijerph192315732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The aim of this study was to explore the experiences of hope people had after undergoing treatment for a hepatitis C virus infection (HCV). Between October 2019 and May 2020, 19 one-on-one interviews were conducted with people who inject drugs and had undergone HCV treatment. All participants had completed treatment and were documented as being virus-free. Data were audio recorded and then transcribed verbatim and analysed; a method inspired by reflexive thematic analysis. Those interviewed conveyed rich and nuanced descriptions of experiences of a life with HCV. Through the course of the analysis we developed four themes. The themes were formulated as metaphors aimed at capturing commonalities about how the participants seemed to "turn their gaze" after receiving HCV treatment: (1) turning their gaze backward; (2) turning their gaze inwards; (3) turning their gaze toward others and (4) turning their gaze forward. Participants' descriptions of their experiences relating to HCV were somewhat gloomy, and HCV treatment seemed to inspire hope and a brighter outlook on several areas of life.
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Affiliation(s)
- Knut Tore Sælør
- Department of Health, Social and Welfare Studies, Center for Mental Health and Substance Abuse, University of South-Eastern Norway, 3007 Drammen, Norway
| | | | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, 5009 Bergen, Norway
| | - Lennart Lorås
- Department of Welfare and Participation, Western Norway University of Applied Sciences, 5063 Bergen, Norway
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Self-reported symptom severity, general health, and impairment in post-acute phases of COVID-19: retrospective cohort study of Swedish public employees. Sci Rep 2022; 12:19818. [PMID: 36396860 PMCID: PMC9672032 DOI: 10.1038/s41598-022-24307-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to examine current symptom severity and general health in a sample of primarily non-hospitalized persons with polymerase chain reaction (PCR) confirmed COVID-19 in comparison to PCR negative controls. During the first quarter of 2021, we conducted an online survey among public employees in West Sweden, with a valid COVID-19 test result. The survey assessed past-month severity of 28 symptoms and signs, self-rated health, the WHO Disability Assessment Schedule (WHODAS) 2.0 and illness severity at the time of test. We linked participants' responses to their SARS-CoV-2 PCR tests results. We compared COVID-19 positive and negative participants using univariable and multivariable regression analyses. Out of 56,221 invited, 14,222 (25.3%) responded, with a response rate of 50% among SARS-CoV-2 positive individuals. Analysis included 10,194 participants (86.4% women, mean age 45 years) who tested positive 4-12 weeks (N = 1425; subacute) and > 12 weeks (N = 1584; postcovid) prior to the survey, and 7185 PCR negative participants who did not believe that they had had COVID-19. Symptoms were highly prevalent in all groups, with worst symptoms in subacute phase participants, followed by postcovid phase and PCR negative participants. The most specific symptom for COVID-19 was loss of smell or taste. Both WHODAS 2.0 score and self-rated health were worst in subacute participants, and modestly worse in postcovid participants than in negative controls. Female gender, older age and acute illness severity had larger effects on self-rated health and WHODAS 2.0 score in PCR positive participants than in PCR negative. Studies with longer follow-up are needed to determine the long-term improvement after COVID-19.
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Ishinuki T, Ota S, Harada K, Kawamoto M, Meguro M, Kutomi G, Tatsumi H, Harada K, Miyanishi K, Kato T, Ohyanagi T, Hui TT, Mizuguchi T. Current standard values of health utility scores for evaluating cost-effectiveness in liver disease: A meta-analysis. World J Gastroenterol 2022; 28:4442-4455. [PMID: 36159009 PMCID: PMC9453766 DOI: 10.3748/wjg.v28.i31.4442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/26/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health utility assessments have been developed for various conditions, including chronic liver disease. Health utility scores are required for socio-economic evaluations, which can aid the distribution of national budgets. However, the standard health utility assessment scores for specific health conditions are largely unknown.
AIM To summarize the health utility scores, including the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), EuroQol-visual analogue scale, short from-36 (SF-36), RAND-36, and Health Utilities Index (HUI)-Mark2/Mark3 scores, for the normal population and chronic liver disease patients.
METHODS A systematic literature search of PubMed and MEDLINE, including the Cochrane Library, was performed. Meta-analysis was performed using the RevMan software. Multiple means and standard deviations were combined using the StatsToDo online web program.
RESULTS The EQ-5D-5L and SF-36 can be used for health utility evaluations during antiviral therapy for hepatitis C. HUI-Mark2/Mark3 indicated that the health utility scores of hepatitis B patients are roughly 30% better than those of hepatitis C patients.
CONCLUSION The EQ-5D-5L is the most popular questionnaire for health utility assessments. Health assessments that allow free registration would be useful for evaluating health utility in patients with liver disease.
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Affiliation(s)
- Tomohiro Ishinuki
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 0608556, Japan
| | - Shigenori Ota
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Kohei Harada
- Department of Radiology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Masaki Kawamoto
- Departments of Surgery, Nemuro City Hospital, Nemuro 0870008, Japan
| | - Makoto Meguro
- Departments of Surgery, Sapporo Satozuka Hospital, Sapporo 0040811, Japan
| | - Goro Kutomi
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University, Sapporo 0608543, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, Sapporo 0608543, Japan
| | - Koji Miyanishi
- Department of Medical Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Toru Kato
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Toshio Ohyanagi
- Department of Liberal Arts and Sciences, Center for Medical Education, Sapporo Medical University, Sapporo 0608556, Japan
| | - Thomas T Hui
- Departments of Surgery, Stanford University School of Medicine, Stanford, 94598, United States
| | - Toru Mizuguchi
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 0608556, Japan
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Donaldson SR, Radley A, Dillon JF. Future destinations and social inclusion scoping review: how people cured of hepatitis C (HCV) using direct- acting antiviral drugs progress in a new HCV-free world. Subst Abuse Treat Prev Policy 2022; 17:45. [PMID: 35676732 PMCID: PMC9178822 DOI: 10.1186/s13011-022-00475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There has been a paradigm shift in the treatment of Hepatitis C (HCV) from the interferon-era to direct-acting antiviral (DAA) drugs. Cure of HCV for the key risk group, those with a history of injecting drug use, may provide a range of benefits to an individual's quality of life that can be additional to that of a clinical cure. The interferon-era provided evidence that cure of HCV can be a turning point for those who use drugs, supporting a recovery journey. There remains a question if DAAs can provide the same opportunity. METHODS We employed a scoping review methodology to consider the additional non-clinical benefits that HCV cure may provide. We used the theoretical construct of recovery capital to consider how these benefits may support a recovery journey in the DAA-era. RESULTS Our search provided 2095 articles, from which 35 were included in the analysis. We developed a thematic synthesis of the non-clinical outcomes identified based on the four over-arching themes of recovery capital: physical, cultural, social and human capital. Our review suggests that identity change is a constituent part of each of the recovery capital domains in relation to HCV treatment. CONCLUSION We identified Social Identity Model Of Recovery (SIMOR) as a mechanism through which DAAs may provide non-clinical outcomes to increase recovery capital domains. Further research is required to develop an understanding of the impact a cure of HCV with DAAs may have on identity, overall health and wellbeing and social inclusion to support recovery journeys.
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Affiliation(s)
- Sarah R Donaldson
- School of Medicine, University of Dundee, Dundee, DD1 9SY, UK.
- NHS Tayside, Dundee, DD1 9SY, UK.
| | - Andrew Radley
- School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
- NHS Tayside, Dundee, DD1 9SY, UK
| | - John F Dillon
- School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
- NHS Tayside, Dundee, DD1 9SY, UK
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11
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Byrne CJ, Radley A, Inglis SK, Beer L, Palmer N, Duc Pham M, Allardice K, Wang H, Robinson E, Hermansson M, Semizarov D, Healy B, Doyle JS, Dillon JF. Reaching people receiving opioid agonist therapy at community pharmacies with hepatitis C virus: an international randomised controlled trial. Aliment Pharmacol Ther 2022; 55:1512-1523. [PMID: 35538396 DOI: 10.1111/apt.16953] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 04/19/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Conventional healthcare models struggle to engage those at risk of hepatitis C virus (HCV) infection. This international study evaluated point-of-care (PoC) HCV RNA diagnostic outreach and direct-acting antiviral (DAA) treatment for individuals receiving opioid agonist therapy (OAT) in community pharmacies. AIMS We assessed the effectiveness of a roving nurse-led pathway offering PoC HCV RNA testing to OAT clients in community pharmacies relative to conventional care. METHODS Pharmacies in Scotland, Wales, and Australia were randomised to provide PoC HCV RNA testing or conventional referral. Pharmacists directed OAT clients to on-site nurses (intervention) or local clinics (control). Infected participants were treated with DAAs, alongside OAT. Primary outcome was the number of participants with sustained virologic response at 12 weeks (SVR) and analysed using mixed effects logistic regression in the intention-to-treat (ITT) population. RESULTS Forty pharmacies were randomised. The ITT population contained 1410 OAT clients. In the conventional arm (n = 648), 62 (10%) agreed to testing, 17 (27%) were tested, 6 (35%) were positive and 5 (83%) initiated treatment. In the intervention arm (n = 762), 148 (19%) agreed to testing, 144 (97%) were tested, 23 (16%) were positive and 22 (96%) initiated treatment. SVR was obtained by 2 (40%; conventional) and 18 (82%; intervention). Intervention arm participants had higher odds of testing, OR 16.95 (7.07-40.64, p < 0.001); treatment, OR 4.29 (1.43-12.92, p = 0.010); and SVR, OR 8.64 (1.82-40.91, p = 0.007). CONCLUSIONS Nurse-led PoC diagnosis in pharmacies made HCV care more accessible for OAT clients relative to conventional care. However, strategies to improve testing uptake are required. TRIAL REGISTRATION NCT03935906.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.,Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Lewis Beer
- Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Nicki Palmer
- Department of Microbiology and Infectious Diseases Cardiff, Public Health Wales, Cardiff, UK
| | - Minh Duc Pham
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kate Allardice
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Huan Wang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Emma Robinson
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - Brendan Healy
- Department of Microbiology and Infectious Diseases Cardiff, Public Health Wales, Cardiff, UK
| | - Joseph S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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12
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Gormley MA, Akiyama MJ, Rennert L, Howard KA, Norton BL, Pericot-Valverde I, Muench S, Heo M, Litwin AH. Changes in Health-related Quality of Life for Hepatitis C Virus-Infected People Who Inject Drugs While on Opioid Agonist Treatment Following Sustained Virologic Response. Clin Infect Dis 2022; 74:1586-1593. [PMID: 34331539 PMCID: PMC9070815 DOI: 10.1093/cid/ciab669] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although efforts to treat hepatitis C virus (HCV) in people who inject drugs (PWID) yield high rates of sustained virologic response (SVR), the relationship between successful HCV treatment and health-related quality of life (HRQOL) among PWID is poorly understood. We examined HRQOL changes throughout HCV treatment and post-treatment for PWID achieving SVR. METHODS Participants included 141 PWID who achieved SVR following HCV treatment onsite at 3 opioid agonist treatment (OAT) clinics in the Bronx, New York. EQ-5D-3L assesses 5 health dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), producing an index of HRQOL ranging from 0 to 1. EQ-5D-3L was measured at baseline; 4, 8, and 12 weeks during treatment; and 12 and 24 weeks post-treatment. Linear mixed effects regression models assessed changes in the mean EQ-5D-3L index over time. RESULTS Mean EQ-5D-3L index baseline was 0.66 (standard error [SE] = 0.02). While over half the population reported no baseline problems with self-care (85.1%), usual activities (56.0%), and mobility (52.5%), at least two-thirds reported problems with pain/discomfort (78.0%) and anxiety/depression (66.0%). Twenty-four weeks post-treatment, proportions reporting pain/discomfort and anxiety/depression decreased by 25.7% and 24.0%, respectively. Mean EQ-5D-3L index significantly improved during treatment (P < .0001), and improvement was sustained following treatment completion, with mean EQ-5D-3L index of 0.77 (SE = 0.02) 12 weeks post-SVR. CONCLUSIONS HCV treatment led to sustained improvement in HRQOL for PWID on OAT who achieved SVR. Future research is necessary to determine whether improvements in HRQOL can be sustained beyond 12 weeks post-SVR.
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Affiliation(s)
- Mirinda Ann Gormley
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Matthew J Akiyama
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Brianna L Norton
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Sam Muench
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson, South Carolina, USA
- Department of Medicine, University of South Carolina School of Medicine, Greenville, South Carolina, USA
- Department of Internal Medicine, Prisma Health, Greenville, South Carolina, USA
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13
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Kotha S, Berry P. Multiple investigations for a very common disorder: Finding the right balance in NAFLD. J Hepatol 2021; 75:1501-1502. [PMID: 34228993 DOI: 10.1016/j.jhep.2021.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom.
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
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14
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Han R, François C, Toumi M. Systematic Review of Health State Utility Values Used in European Pharmacoeconomic Evaluations for Chronic Hepatitis C: Impact on Cost-Effectiveness Results. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:29-44. [PMID: 32661846 DOI: 10.1007/s40258-020-00600-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health state utility values (HSUVs) identified from utility elicitation studies are widely used in pharmacoeconomic evaluations for chronic hepatitis C (CHC) and are particularly instrumental in health technology assessment (HTA) evaluations such as those from the National Institute for Health and Care Excellence (NICE). OBJECTIVE The aim of this study was to identify HSUVs used in cost-utility analyses (CUAs) for CHC in Europe and to evaluate the impact of HSUV selection on cost-effectiveness results in terms of the incremental cost per quality-adjusted life-year (QALY) gained (ICER). METHODS A systematic search of pharmacoeconomic evaluations for CHC was updated in the MEDLINE and EMBASE databases for the periods 2012-2017 and 2017-2020. Data on health states, HSUVs, and utility elicitation studies were extracted. The difference in HSUVs of the same health state in different CUAs, and the difference between HSUVs of one health state and of the interlink health state in the same CUAs, were calculated. A quality assessment was performed to evaluate the selection of HSUVs in CUAs. Sets of HSUVs identified were used in a reconstructed CUA model to assess the impact on the ICER. RESULTS Twenty-six CUAs conducted in European countries and referring to 17 utility elicitation studies were included. The difference in HSUVs of the same health state in different CUAs ranged from 0.021 (liver transplant) to 0.468 (decompensated cirrhosis). The difference between HSUVs of one health state and of the interlink health state of the next disease severity level was calculated between the health states of F0-F1/mild and F2-F3/moderate (n = 11, 0.040-0.110), F2-F3/moderate and F4/compensated cirrhosis (n = 18, 0.027-0.130), compensated cirrhosis and decompensated cirrhosis (n = 22, 0.020-0.100), decompensated cirrhosis and hepatocellular carcinoma (n = 24, 0.000-0.200), hepatocellular carcinoma and liver transplant in the first year (n = 17, - 0.329 to 0.170) and liver transplant in the first and subsequent years (n = 17, - 0.340 to 0.000). The utility elicitation study selected by most CUAs (n = 11) was recommended as the source of HSUVs, at least for the CUAs conducted in the UK, based on the results of quality assessment. Seven sets of HSUVs were generated to fit the reconstructed model and changed the results of the incremental analysis from being cost effective to not being cost effective (ICER ranging from £2460 to £24,954 per QALY gained), and to being dominated in the UK setting. CONCLUSIONS The CUAs for CHC were found to apply to various HSUVs from different utility elicitation studies in the same health state. This variability in HSUVs has the potential to significantly affect ICER and ICER-based reimbursement decisions. A rigorous selection of HSUVs in CUAs to inform healthcare resource allocation is suggested for future studies of CUAs and for guideline development.
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Affiliation(s)
- Ru Han
- University of Aix-Marseille, Marseille, France.
- Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France.
| | - Clément François
- University of Aix-Marseille, Marseille, France
- Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
| | - Mondher Toumi
- University of Aix-Marseille, Marseille, France
- Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
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15
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Ward Z, Reynolds R, Campbell L, Martin NK, Harrison G, Irving W, Hickman M, Vickerman P. Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England. Addiction 2020; 115:1509-1521. [PMID: 31984606 PMCID: PMC10762643 DOI: 10.1111/add.14978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/04/2019] [Accepted: 01/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres in England. DESIGN HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. SETTING England-specific epidemic with 40% prevalence of chronic HCV among PWID. PARTICIPANTS PWID attending drug treatment centres. INTERVENTION Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway. MEASUREMENTS Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding. FINDINGS Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030. CONCLUSIONS Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.
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Affiliation(s)
- Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Rosie Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Linda Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | | | - William Irving
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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16
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Ward Z, Campbell L, Surey J, Platts S, Glass R, Hickman M, Story A, Vickerman P. The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK. J Antimicrob Chemother 2020; 74:v5-v16. [PMID: 31782503 PMCID: PMC6883400 DOI: 10.1093/jac/dkz451] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background HCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care. Objectives To assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care). Methods Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon. Results For a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY). Conclusions New models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.
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Affiliation(s)
- Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Linda Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Rachel Glass
- HIV & STI Department, National Infection Service, Public Health England, London, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alistair Story
- Institute of Global Health, University College London, London, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Rashidi A, Higgs P, Carruthers S. Aboriginal people with chronic HCV: The role of community health nurses for improving health-related quality of life. Collegian 2020. [DOI: 10.1016/j.colegn.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Saeed YA, Phoon A, Bielecki JM, Mitsakakis N, Bremner KE, Abrahamyan L, Pechlivanoglou P, Feld JJ, Krahn M, Wong WWL. A Systematic Review and Meta-Analysis of Health Utilities in Patients With Chronic Hepatitis C. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:127-137. [PMID: 31952667 DOI: 10.1016/j.jval.2019.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/19/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic hepatitis C (CHC) is among the most burdensome infectious diseases in the world. Health utilities are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE Our study summarizes the available data on utilities in CHC patients. This will facilitate analyses of CHC treatment and elimination strategies. METHODS We searched MEDLINE, Embase, and the Cochrane Library for studies measuring utilities in CHC patients. Utilities were pooled by health state and utility instrument using meta-analysis. A further analysis used meta-regression to adjust for the effects of clinical status and methodological variation. RESULTS Fifty-one clinical studies comprising 15 053 patients were included. Based on the meta-regression, patients' utilities were lower for more severe health states (predicted mean EuroQol-5D-3L utility for mild/moderate CHC: 0.751; compensated cirrhosis: 0.671; hepatocellular carcinoma: 0.662; decompensated cirrhosis: 0.602). Patients receiving interferon-based treatment had lower utilities than those on interferon-free treatment (0.647 vs 0.733). Patients who achieved sustained virologic response (0.786) had higher utilities than those with mild to moderate CHC. Utilities were substantially higher for patients in experimental studies compared to observational studies (coefficient: +0.074, P < .05). The time tradeoff instrument was associated with the highest utilities, and the Health Utilities Index 3 was associated with the lowest utilities. CONCLUSION Chronic hepatitis C is associated with a significant impairment in global health status, as measured by health utility instruments. Impairment is greater in advanced disease. Experimental study designs yield higher utilities-an effect not previously documented. Curative therapy can alleviate the burden of CHC, although further research is needed in certain areas, such as the long-term impacts of treatment on utilities.
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Affiliation(s)
- Yasmin A Saeed
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
| | - Arcturus Phoon
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Nicholas Mitsakakis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON, Canada
| | - Murray Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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19
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Hickman M, Dillon JF, Elliott L, De Angelis D, Vickerman P, Foster G, Donnan P, Eriksen A, Flowers P, Goldberg D, Hollingworth W, Ijaz S, Liddell D, Mandal S, Martin N, Beer LJZ, Drysdale K, Fraser H, Glass R, Graham L, Gunson RN, Hamilton E, Harris H, Harris M, Harris R, Heinsbroek E, Hope V, Horwood J, Inglis SK, Innes H, Lane A, Meadows J, McAuley A, Metcalfe C, Migchelsen S, Murray A, Myring G, Palmateer NE, Presanis A, Radley A, Ramsay M, Samartsidis P, Simmons R, Sinka K, Vojt G, Ward Z, Whiteley D, Yeung A, Hutchinson SJ. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol). BMJ Open 2019; 9:e029538. [PMID: 31551376 PMCID: PMC6773339 DOI: 10.1136/bmjopen-2019-029538] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV 'Treatment as Prevention' (TasP) in PWID. METHODS AND ANALYSIS We plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome - chronic HCV prevalence in PWID - is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a 'virtual cohort' of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes. ETHICS AND DISSEMINATION Extending HCV community care pathways is covered by ethics (ERADICATE C, ISRCTN27564683, Super DOT C Trial clinicaltrials.gov: NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.
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Affiliation(s)
- Matthew Hickman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - John F Dillon
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Daniela De Angelis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Graham Foster
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | | | | | - David Goldberg
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | | | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | | | - Sema Mandal
- National Infection Service, Public Health England, London, UK
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, UK
| | - Lewis J Z Beer
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Kate Drysdale
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Rachel Glass
- National Infection Service, Public Health England, London, UK
| | | | - Rory N Gunson
- West Of Scotland Specialist Virology Centre, NHS Greater Glasgow & Clyde Board, Glasgow, UK
| | | | - Helen Harris
- National Infection Service, Public Health England, London, UK
| | | | - Ross Harris
- National Infection Service, Public Health England, London, UK
| | | | - Vivian Hope
- Liverpool John Moores University, Liverpool, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Sarah Karen Inglis
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Hamish Innes
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Jade Meadows
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | | | - Gareth Myring
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Norah E Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Anne Presanis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Radley
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Mary Ramsay
- National Infection Service, Public Health England, London, UK
| | - Pantelis Samartsidis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Simmons
- National Infection Service, Public Health England, London, UK
| | - Katy Sinka
- National Infection Service, Public Health England, London, UK
| | | | - Zoe Ward
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | - Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
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20
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Schulkind J, Stephens B, Ahmad F, Johnston L, Hutchinson S, Thain D, Ward Z, Vickerman P, Hickman M, Dillon JF. High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme. J Viral Hepat 2019; 26:519-528. [PMID: 30422370 DOI: 10.1111/jvh.13035] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022]
Abstract
To achieve WHO hepatitis C virus (HCV) elimination targets by 2030, mathematical models suggest there needs to be significant scale-up of treatment among people who inject drugs (PWID). We tested whether people who actively inject drugs can be recruited and treated successfully through a community needle and syringe programme (NSP), and assessed rates of re-infection. 105 HCV RNA positive participants were enrolled prospectively. Participants were recruited from the largest NSP in Dundee over 42 months. 94/105 individuals commenced treatment. Genotype 1 (G1) individuals (n = 37) were treated with peg-interferon+ribavirin+Simepravir/Telaprevir. Genotype 2/3 (G2/3) (n = 57) received peg-interferon+ribavirin. Weekly study visits took place within the NSP. Mean age of participants was 34.0 years (SD 6.9), 71.3% (61/94) were male. One in five (20/94) participants were homeless. 68.1% (64/94) were on OST (opiate substitution therapy) at enrolment; participants injected median 6.5 times/wk. In terms of clinical outcomes, >80% treatment adherence was 71.3% (67/94). There was no difference in SVR-12 rates by genotype: 81.0% (30/37) for G1 and 82.5% (47/55) for G2/3. At 18 months post-treatment, 15/77 participants were reinfected, followed up over 69.8 person-years, yielding a re-infection rate of 21.5/100 person-years (95% CI 13.00-35.65). This trial demonstrates that HCV treatment can be delivered successfully to the target population of treatment as prevention strategies. We report higher rates of re-infection than existing estimates among PWID. Scale-up of HCV treatment should be pursued alongside a comprehensive programme of harm reduction interventions to help minimize re-infection and reduce HCV transmission.
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Affiliation(s)
| | - Brian Stephens
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Farsana Ahmad
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Linda Johnston
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Donna Thain
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matt Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - John F Dillon
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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21
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Girardin F, Hearmon N, Negro F, Eddowes L, Bruggmann P, Castro E. Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost-effectiveness analysis. J Viral Hepat 2019; 26:236-245. [PMID: 30338887 DOI: 10.1111/jvh.13023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/18/2018] [Indexed: 01/20/2023]
Abstract
People who inject drugs (PWID) are a key high-risk group for Hepatitis C Virus (HCV) infection due to the sharing of needles and drug-preparation equipment. However, only approximately 50% of PWID are currently screened for HCV in Switzerland. At present, screening of PWID occurs in general practice via venepuncture. Compared to venepuncture, screening via rapid antibody saliva and dried blood spot (DBS) tests is well adapted to PWID, who typically have difficult venous access. The cost-effectiveness of an increased access screening programme of PWID (increased screening using rapid antibody saliva tests and DBS tests [semi-quantitative viraemia and viral genotype]) was analysed through a decision tree screening model combined with the outputs of a Markov treatment model. Sensitivity and scenario analyses examined the uncertainty of results. At a willingness to pay (WTP) threshold of CHF 100 000 (USD 105 000) per quality-adjusted life year (QALY), the increased access screening programme was cost-effective compared to current screening, with a base case incremental cost-effectiveness ratio of CHF 7 940 (USD 8337) per QALY. The net monetary benefit was CHF 959 802 668 (USD 1 007 792 801) for the PWID population and CHF 94 469 (USD 99 192) per person. The increased access screening programme had a 97.0% probability of being cost-effective compared to the current screening method at the WTP threshold of CHF 100 000 (USD 105 000). The results showed an increased access screening programme that uses tests which are better suited to the PWID population to be more cost-effective, due to the increased uptake that rapid antibody saliva and DBS tests generate.
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Affiliation(s)
- François Girardin
- Medical Direction and Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.,Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
| | | | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, HUG, Geneva, Switzerland
| | | | | | - Erika Castro
- Center for Addiction Medicine, Service of Community Psychiatry, Department of Psychiatry, University of Lausanne (CHUV), Lausanne, Switzerland
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22
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Yamagiwa Y, Masaki N. Factors improving the utility of antiviral therapy for chronic hepatitis B: A nationwide multicenter study in Japan. Hepatol Res 2018; 48:1069-1080. [PMID: 29934990 DOI: 10.1111/hepr.13221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/30/2018] [Accepted: 06/16/2018] [Indexed: 12/17/2022]
Abstract
AIM The consideration of patients' needs in terms of research outcomes is emphasized in research promotion to eradicate hepatitis B virus according to the Basic Act on Hepatitis Measures in Japan. This study analyzed patients' attitudes toward experienced antiviral therapies for chronic hepatitis B and their need for future therapies. METHODS A self-administered questionnaire comprising 124 questions was completed among patients with chronic hepatitis B from 61 core-center hospitals designated to implement and research policies on hepatitis in 47 prefectures from August 2013 to January 2014 (n = 3021, response rate = 51%). RESULTS In decision-tree models with 333 variables generated from the questionnaire data, patients' satisfaction with therapy and reduction in anxiety about therapy were dependent on favorable therapeutic effects, sufficient information provided by the physician, and fewer lifestyle disturbances. Medical expenses were not selected at a superior branch because subsidy for antiviral therapy started in 2010. In correspondence analysis of free text answers, patients' need for therapy and support mechanisms differed among their attributes, including a great need for novel therapy in older men, hope for avoidance of lifestyle disturbance in younger men, and alleviation of painful experience with the disease in women. CONCLUSIONS Continual provision of sufficient information is necessary to improve the utility of antiviral therapy for chronic hepatitis B as well as for favorable therapeutic effects. The patients believed that novel drugs and support would reduce the diverse burden of the disease on their lives.
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Affiliation(s)
- Yoko Yamagiwa
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan.,Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Naohiko Masaki
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan.,Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
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23
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Too much medicine: overdiagnosis and overtreatment of non-alcoholic fatty liver disease. Lancet Gastroenterol Hepatol 2018; 3:66-72. [PMID: 29254617 DOI: 10.1016/s2468-1253(17)30142-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/07/2017] [Accepted: 04/12/2017] [Indexed: 12/25/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease. This remarkable rise in prevalence over the past 20 years is largely through the recognition of fatty liver in the absence of excessive alcohol consumption as a disease. The natural history of NAFLD is incompletely understood, and although a small proportion of individuals with NAFLD will develop complications of liver disease, most will not. This raises the prospect of widespread overdiagnosis of NAFLD. Clinical practice guidelines from the European specialist societies representing hepatology, endocrinology, and obesity endorse screening for NAFLD in at-risk groups, and this further increases the likelihood of overdiagnosis and consequent overtreatment through false-positive testing. Predictable outcomes of overdiagnosis include physical harms through investigation and treatment, and psychosocial harms through disease labelling. Prospective studies are required to better understand both the benefits and risks associated with an early diagnosis of NAFLD.
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24
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Buchanan-Hughes AM, Buti M, Hanman K, Langford B, Wright M, Eddowes LA. Health state utility values measured using the EuroQol 5-dimensions questionnaire in adults with chronic hepatitis C: a systematic literature review and meta-analysis. Qual Life Res 2018; 28:297-319. [PMID: 30225787 DOI: 10.1007/s11136-018-1992-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Chronic hepatitis C infection and its treatment can considerably affect patients' health-related quality-of-life (HRQoL). This study aimed to identify and summarise the current evidence base for health state utility values (HSUVs) in patients with chronic hepatitis C infection, generated using the EuroQol 5-dimensions (EQ-5D) questionnaire. METHODS MEDLINE, Embase, the Cochrane Library and EconLit were searched from database inception through 31 August 2017. Eligible studies reported HSUVs elicited using the EQ-5D questionnaire in adults with chronic hepatitis C infection. Study quality and risk of bias were assessed. RESULTS Of 1480 records identified, 26 studies were included. The most commonly defined health states described different stages of chronic hepatitis C infection and specific liver-related disease states, including METAVIR score, compensated and decompensated cirrhosis, hepatocellular carcinoma and liver transplantation. Patients with higher METAVIR scores tended to have lower EQ-5D scores compared to patients with lower METAVIR scores. Patients that achieved sustained virologic responses tended to have higher EQ-5D scores compared to those that did not. A meta-analysis conducted on three studies confirmed that patients with decompensated cirrhosis have significantly lower HSUVs than patients with compensated cirrhosis [mean difference - 0.11 (95% CI - 0.19 to - 0.04)], implying worse HRQoL. However, there was not sufficient evidence to compare how different treatments for chronic hepatitis C infection affect EQ-5D scores. CONCLUSIONS This study provides a summary of EQ-5D HSUVs for patients with chronic hepatitis C infection, and demonstrates that clinically important disease stages associated with treatment decisions are associated with differences in HRQoL.
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Affiliation(s)
| | - M Buti
- Hospital Universitario Valle Hebron, Barcelona, Spain.,Ciberehd del Instituto Carlos III, Madrid, Spain
| | - K Hanman
- Costello Medical Consulting Ltd, Cambridge, UK
| | - B Langford
- Costello Medical Consulting Ltd, Cambridge, UK
| | - M Wright
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L A Eddowes
- Costello Medical Consulting Ltd, Cambridge, UK
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25
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Wisløff T, White R, Dalgard O, Amundsen EJ, Meijerink H, Kløvstad H. Feasibility of reaching world health organization targets for hepatitis C and the cost-effectiveness of alternative strategies. J Viral Hepat 2018; 25:1066-1077. [PMID: 29624813 DOI: 10.1111/jvh.12904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/09/2018] [Indexed: 12/13/2022]
Abstract
New drugs for treating hepatitis C have considerably increased the probability of being cured. Treatment uptake, however, is still low. The objectives of this study were to analyse the impact of initiatives that may increase the proportion of infected people on treatment and interventions aimed at reducing the incidence of new infection among people who inject drugs. A compartmental model for Norway was used to simulate hepatitis C and related complications. We analysed 2 different screening initiatives aimed to increase the proportion of infected people on treatment. Interventions aiming at reducing the hepatitis C incidence analysed were opioid substitution therapy (OST), a clean needle and syringe programme and a combination of both. The most cost-effective strategy for increasing hepatitis C treatment uptake was screening by general practitioners while simultaneously allowing for all infected people to be treated. We estimated that this intervention reduces the incidence of hepatitis C by 2030 by 63% compared with the current incidence. The 2 harm reduction strategies both reduced the incidence of hepatitis C by about 70%. Combining an increase in the current clean needles and syringe programme with OST was clearly the most cost-effective option. This strategy would reduce the incidence of hepatitis C by 80% compared with the current incidence by 2030. Thus, interventions to reduce the burden and spread of hepatitis C are cost-effective. Reaching the WHO target of a 90% reduction in hepatitis C incidence by 2030 may be difficult without combining different initiatives.
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Affiliation(s)
- T Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - R White
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - O Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.,Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
| | - E J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - H Meijerink
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - H Kløvstad
- Department of Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute of Public Health, Oslo, Norway
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26
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Wisløff T, White R, Dalgard O, Amundsen EJ, Meijerink H, Løvlie AL, Kløvstad H. Economic Evaluation of Direct-Acting Antivirals for Hepatitis C in Norway. PHARMACOECONOMICS 2018; 36:591-601. [PMID: 29396744 PMCID: PMC5906515 DOI: 10.1007/s40273-017-0604-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE New direct-acting antiviral (DAA) drugs have revolutionized the treatment of hepatitis C in recent years. OBJECTIVE Our objective was to analyse the cost effectiveness of combinations of different DAAs compared with ribavirin and peginterferon-α-2a, taking into account rebates from tender negotiations. METHODS We used a compartmental model specifically developed for Norway to simulate hepatitis C and complications with and without different DAAs. All costs were based on Norwegian fees and estimates, estimating healthcare sector costs for the year 2016. We performed Monte Carlo simulations on uncertain input parameters to facilitate probabilistic sensitivity analyses. RESULTS For patients diagnosed with genotype 1, the combination of paritaprevir, ritonavir, ombitasvir and dasabuvir was cost effective compared with eight other available alternatives, given a cost-effectiveness threshold of €70,000 per quality-adjusted life-year. For genotype 2, the combination of sofosbuvir and ribavirin was the most effective and cost-effective alternative for all patients. Among available alternatives for patients with genotype 3, sofosbuvir in combination with peginterferon and ribavirin was the most cost-effective alternative, although the combination of daclatasvir and sofosbuvir was somewhat more effective. CONCLUSIONS For each of the hepatitis C genotypes 1, 2 and 3, there were combinations of DAAs that were cost effective in a Norwegian setting. As a result of recent tender negotiations in Norway, treating all diagnosed patients with hepatitis C with the most cost-effective DAAs will result in lower total expenditure on these medications compared with 2015.
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Affiliation(s)
- Torbjørn Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Richard White
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
| | - Ellen J Amundsen
- Department of Substance Use, Norwegian Institute of Public Health, Oslo, Norway
| | - Hinta Meijerink
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Astrid Louise Løvlie
- Department of Infectious Disease Registries, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde Kløvstad
- Department of Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute of Public Health, Oslo, Norway
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27
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Ng X, Nwankwo C, Arduino JM, Corman S, Lasch KE, Lustrino JM, Patel S, Platt HL, Qiu J, Sperl J. Patient-reported outcomes in individuals with hepatitis C virus infection treated with elbasvir/grazoprevir. Patient Prefer Adherence 2018; 12:2631-2638. [PMID: 30587935 PMCID: PMC6294167 DOI: 10.2147/ppa.s172732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE People chronically infected with hepatitis C virus (HCV) have diminished patient-reported outcomes (PROs). This study aimed to compare the impact of elbasvir/grazoprevir (EBR/GZR) treatment versus sofosbuvir with pegylated interferon and ribavirin (SOF/PR) on changes in PROs: 1) during the treatment period and 2) at posttreatment follow-up. PATIENTS AND METHODS PRO data collected during the Phase III C-EDGE Head-2-Head (H2H) open-label study was analyzed. In this trial, patients infected with HCV were randomized 1:1 to receive either EBR/GZR or SOF/PR for 12 weeks. Patients self-administered the Short Form-36 version 2 (SF-36v2®) Health Survey Acute (1-week recall) Form and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale at baseline, during treatment, and posttreatment. Between-group differences in mean change of PRO scores from baseline were estimated during the treatment period and also at the posttreatment follow-up. Effect sizes were calculated to evaluate if the detected change in mean PRO scores is clinically meaningful between groups. RESULTS There were 255 patients (99.2% White, 54.1% female, 74.9% treatment naïve) included in the analysis. During the treatment period, significant declines in SF-36v2 scores were observed across all domains for the SOF/PR group. Compared to the SOF/PR group, the EBR/GZR group reported more improvement in scores across all SF-36v2 domain scores at the end of the treatment period. At treatment week 12, the between-group differences for 6 out of the 8 domain scores for these patients reflected at least moderate effects (effect sizes >0.5). No significant between-group differences in change in SF-36v2 scores from baseline were detected posttreatment. The decline in SF-36v2 scores observed during the treatment period for the SOF/PR group returned to near baseline scores or above posttreatment. Treatment with EBR/GZR did not impact fatigue scores, but treatment with SOF/PR led to increased fatigue scores during treatment which resolved by posttreatment follow-up week 12. CONCLUSION This study demonstrated that HCV treatment with EBR/GZR resulted in a significantly better PRO profile as compared to SOF/PR. PROs are an important consideration as worsening PROs experienced during treatment may negatively influence adherence and ultimately contribute to an unfavorable clinical outcome. CLINICALTRIALSGOV IDENTIFIER NCT02358044.
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Affiliation(s)
- Xinyi Ng
- Pharmerit International, LP, Bethesda, MD, USA,
| | | | | | | | | | | | | | | | | | - Jan Sperl
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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28
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Beattie A, Marques EMR, Barber M, Greenwood R, Ingram J, Ayres R, Neale J, Rees A, Coleman B, Hickman M. Script in a Day intervention for individuals who are injecting opioids: a feasibility randomized control trial. J Public Health (Oxf) 2016; 38:712-721. [PMID: 28158697 DOI: 10.1093/pubmed/fdv161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angela Beattie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Elsa M R Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Rosemary Greenwood
- NIHR Research Design Service-South West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jennifer Ingram
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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29
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Martin NK, Vickerman P, Brew IF, Williamson J, Miners A, Irving WL, Saksena S, Hutchinson SJ, Mandal S, O’Moore E, Hickman M. Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis. Hepatology 2016; 63:1796-808. [PMID: 26864802 PMCID: PMC4920048 DOI: 10.1002/hep.28497] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/08/2016] [Indexed: 12/31/2022]
Abstract
UNLABELLED Prisoners have a high prevalence of hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity of care. We assessed the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons compared to status quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8-24 weeks) or interferon (IFN)-free direct-acting antivirals (DAAs; 8-12 weeks, 95% sustained virological response, £3300/week). Costs (British pounds, £) and health utilities (quality-adjusted life years) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assumed 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/ex-PWID treated within 2 months of diagnosis in prison. PWID and ex-PWID or non-PWID are in prison an average 4 and 8 months, respectively. Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/quality-adjusted life years gained compared to current testing/treatment and is 45% likely to be cost-effective under a £20,000 willingness-to-pay threshold. Switching to 8-week to 12-week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/quality-adjusted life years gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or with 8 weeks' duration. CONCLUSIONS Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status quo voluntary risk-based testing under a £20,000 willingness to pay with current treatments but likely to be cost-effective if short-course IFN-free DAAs are used and could be highly cost-effective if PWID treatment rates were increased. (Hepatology 2016;63:1796-1808).
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Affiliation(s)
- Natasha K Martin
- Division of Global Public Health, University of California San Diego, USA
- School of Social and Community Medicine, University of Bristol, UK
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, UK
| | | | | | - Alec Miners
- London School of Hygiene and Tropical Medicine, UK
| | | | | | | | | | | | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
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30
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Bird SM, McAuley A, Perry S, Hunter C. Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison. Addiction 2016; 111:883-91. [PMID: 26642424 PMCID: PMC4982071 DOI: 10.1111/add.13265] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/15/2015] [Accepted: 11/30/2015] [Indexed: 12/26/2022]
Abstract
AIMS To assess the effectiveness for Scotland's National Naloxone Programme (NNP) by comparison between 2006-10 (before) and 2011-13 (after NNP started in January 2011) and to assess cost-effectiveness. DESIGN This was a pre-post evaluation of a national policy. Cost-effectiveness was assessed by prescription costs against life-years gained per opioid-related death (ORD) averted. SETTING Scotland, in community settings and all prisons. INTERVENTION Brief training and standardized naloxone supply became available to individuals at risk of opioid overdose. MEASUREMENTS ORDs as identified by National Records of Scotland. Look-back determined the proportion of ORDs who, in the 4 weeks before ORD, had been (i) released from prison (primary outcome) and (ii) released from prison or discharged from hospital (secondary). We report 95% confidence intervals for effectiveness in reducing the primary (and secondary) outcome in 2011-13 versus 2006-10. Prescription costs were assessed against 1 or 10 life-years gained per averted ORD. FINDINGS In 2006-10, 9.8% of ORDs (193 of 1970) were in people released from prison within 4 weeks of death, whereas only 6.3% of ORDs in 2011-13 followed prison release (76 of 1212, P < 0.001; this represented a difference of 3.5% [95% confidence interval (CI) = 1.6-5.4%)]. This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs (95% CI = 19-65) during 2011-13, when 12,000 naloxone kits were issued at current prescription cost of £225,000. Scotland's secondary outcome reduced from 19.0 to 14.9%, a difference of 4.1% (95% CI = 1.4-6.7%). CONCLUSIONS Scotland's National Naloxone Programme, which started in 2011, was associated with a 36% reduction in the proportion of opioid-related deaths that occurred in the 4 weeks following release from prison.
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Affiliation(s)
- Sheila M. Bird
- MRC Biostatistics UnitCambridgeUK
- Department of Mathematics and StatisticsStrathclyde UniversityGlasgowUK
| | - Andrew McAuley
- NHS Health ScotlandPublic Health Science DirectorateGlasgowUK
- Institute for Applied Health Research, School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | | | - Carole Hunter
- Addiction Services for NHS Greater Glasgow and ClydePossilpark Health and Care CentreGlasgowUK
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31
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Doyle JS, Aspinall EJ, Hutchinson SJ, Quinn B, Gore C, Wiktor SZ, Hellard ME. Global policy and access to new hepatitis C therapies for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1064-71. [DOI: 10.1016/j.drugpo.2015.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/05/2015] [Accepted: 05/25/2015] [Indexed: 02/08/2023]
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32
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Health-Related Quality of Life for individuals with hepatitis C: A narrative review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:936-49. [DOI: 10.1016/j.drugpo.2015.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/10/2015] [Accepted: 04/24/2015] [Indexed: 02/06/2023]
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Expansion of HCV treatment access to people who have injected drugs through effective translation of research into public health policy: Scotland's experience. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1041-9. [PMID: 26123893 DOI: 10.1016/j.drugpo.2015.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/11/2015] [Accepted: 05/31/2015] [Indexed: 01/15/2023]
Abstract
Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan - a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multi-disciplinary multi-agency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by non-clinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as "an impressive example of a national strategy" by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID.
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Ford N, Wiktor S, Kaplan K, Andrieux-Meyer I, Hill A, Radhakrishnan P, Londeix P, Forette C, Momenghalibaf A, Verster A, Swan T. Ten priorities for expanding access to HCV treatment for people who inject drugs in low- and middle-income countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1088-93. [PMID: 26074094 DOI: 10.1016/j.drugpo.2015.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/16/2015] [Accepted: 05/07/2015] [Indexed: 01/22/2023]
Abstract
Of the estimated 130-150 million people who are chronically infected with hepatitis C virus, around 90% reside in low- and middle-income countries. People who inject drugs are disproportionately affected by HCV, with a global estimated prevalence (based on serological reports of HCV antibodies) of 67%; world-wide over 10 million people who inject drugs are infected with HCV. Treatment for HCV has improved dramatically in recent years with the arrival of new direct acting antivirals (DAAs) and this is stimulating considerable efforts to scale up access to treatment. However, treatment coverage among the general population is less than 10% in most countries, and coverage for people who inject drugs is generally much lower. It is estimated that globally around 2 million people who inject drugs need treatment for HCV. The DAAs offer significant potential to rapidly expand access to treatment for HCV. While the ideal combination therapy remains to be established, key characteristics include high efficacy, tolerability, pan-genotypic activity, short treatment duration, oral therapy, affordability, limited drug-drug interactions, and availability as fixed-dose combinations and once daily treatments. This paper outlines 10 key priorities for improving access to HCV treatment for people who inject drugs: (1) affordable access to direct acting antivirals; (2) increased awareness and testing; (3) standardization of treatment; (4) simplification of service delivery; (5) integration of services; (6) peer support; (7) treatment within a framework of comprehensive prevention; (8) tracking progress; (9) dedicated funding; and (10) enabling policies.
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Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.
| | - Stefan Wiktor
- Department of HIV/AIDS and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | | | - Annette Verster
- Department of HIV/AIDS and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
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Lourenço S, Lucas R, Araújo F, Bogas M, Santos RA, Barros H. Osteoarthritis medical labelling and health-related quality of life in the general population. Health Qual Life Outcomes 2014; 12:146. [PMID: 25433808 PMCID: PMC4260189 DOI: 10.1186/s12955-014-0146-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 09/12/2014] [Indexed: 11/13/2022] Open
Abstract
Background Osteoarthritis is the most common chronic joint disease. In the absence of an effective medical treatment and due to the chronic nature of this condition, an osteoarthritis medical diagnosis may finally result in decreased health-related quality of life. Therefore, the aim of this study was to measure the impact of the osteoarthritis medical labelling on physical and mental health-related quality of life. Methods Subjects (n = 1132, 58.7% women) were approached as participants of an urban population-based cohort (EPIPorto). Self-reported information on previous diagnosis of knee, hip or hand osteoarthritis was obtained and rheumatologists established knee, hip or hand osteoarthritis clinical diagnosis in symptomatic individuals. Physical and mental dimensions of health-related quality of life were evaluated using the self-administered Medical Outcomes Study: 36-Item Short Form Survey. Crude and adjusted linear regression coefficients (beta) and the corresponding 95% confidence intervals (95% CI) were computed to estimate the associations between being labelled as an osteoarthritis case and health-related quality of life. Results Regardless of disease medical labelling, individuals with osteoarthritis scored significantly lower physical health-related quality of life when compared to those without joint disease (kneeunexposed: beta = −5.3, 95% CI: −7.6, −3.1; kneeexposed: beta = −6.0, 95% CI: −8.4, −3.7; hipunexposed: beta = −6.0, 95% CI: −9.8, −2.3; hipexposed: beta = −11.0, 95% CI: −15.6, −6.4; handunexposed: beta = −4.3, 95% CI: −6.5, −2.0; handexposed: beta = −4.3, 95% CI: −6.6, −2.1). The same was not observed regarding mental health-related quality of life. Among subjects with clinically confirmed osteoarthritis, the medical labelling of this joint disease was not significantly associated to health-related quality of life. Conclusions The labelling of knee, hip and hand osteoarthritis diagnosis may not add specific benefit to osteoarthritis patients in terms of its capability to improve health-related quality of life.
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Affiliation(s)
- Sara Lourenço
- Institute of Public Health of the University of Porto, Rua das Taipas, 135-139, 4050-600, Porto, Portugal.
| | - Raquel Lucas
- Institute of Public Health of the University of Porto, Rua das Taipas, 135-139, 4050-600, Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health of the University of Porto Medical School, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Fábio Araújo
- Institute of Public Health of the University of Porto, Rua das Taipas, 135-139, 4050-600, Porto, Portugal.
| | - Mónica Bogas
- Ponte de Lima Hospital, Largo Conde de Bertiandos, 4990-041, Ponte de Lima, Portugal.
| | - Rui André Santos
- Beatriz Ângelo Hospital, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal.
| | - Henrique Barros
- Institute of Public Health of the University of Porto, Rua das Taipas, 135-139, 4050-600, Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health of the University of Porto Medical School, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, Hatzakis A, Prins M, Vickerman P, Lazarus JV, Hope VD, Matheï C. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PLoS One 2014; 9:e103345. [PMID: 25068274 PMCID: PMC4113410 DOI: 10.1371/journal.pone.0103345] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/29/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. METHODS AND FINDINGS We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally 'difficult to treat' genotypes (G1+G4) showed large variation (median 53, IQR 43-62). Twelve countries reported on HCV chronicity (median 72, IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38-64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5-15). Burden of disease, where assessed, was high and will rise in the next decade. CONCLUSION Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Bart Grady
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Kantzanou
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Ida Sperle
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katelyn J. Cullen
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | | | - Angelos Hatzakis
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Maria Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Peter Vickerman
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jeffrey V. Lazarus
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vivian D. Hope
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Catharina Matheï
- Department of Public Health and Primary Care, KULeuven, Leuven, Belgium
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Martin NK, Hickman M, Miners A, Hutchinson SJ, Taylor A, Vickerman P. Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons. BMJ Open 2013; 3:e003153. [PMID: 23943776 PMCID: PMC3752052 DOI: 10.1136/bmjopen-2013-003153] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES People who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV), but many are unaware of their infection. HCV dried blood spot (DBS) testing increases case-finding in addiction services and prisons. We determine the cost-effectiveness of increasing HCV case-finding among PWID by offering DBS testing in specialist addiction services or prisons as compared to using venepuncture. DESIGN Cost-utility analysis using a dynamic HCV transmission model among PWID, including: disease progression, diagnosis, treatment, injecting status, incarceration and addition services contact. SETTING UK INTERVENTION DBS testing in specialist addiction services or prisons. Intervention impact was determined by a meta-analysis of primary data. PRIMARY AND SECONDARY OUTCOME MEASURES Costs (in UK £, £1=US$1.60) and utilities (quality-adjusted life years, QALYs) were attached to each state and the incremental cost effectiveness ratio (ICER) determined. Multivariate uncertainty and one-way sensitivity analyses were performed. RESULTS For a £20 000 per QALY gained willingness-to-pay threshold, DBS testing in addiction services is cost-effective (ICER of £14 600 per QALY gained). Under the base-case assumption of no continuity of treatment/care when exiting/entering prison, DBS testing in prisons is not cost-effective (ICER of £59 400 per QALY gained). Results are robust to changes in HCV prevalence; increasing PWID treatment rates to those for ex-PWID considerably reduces ICER (£4500 and £30 000 per QALY gained for addiction services and prison, respectively). If continuity of care is >40%, the prison DBS ICER falls below £20 000 per QALY gained. CONCLUSIONS Despite low PWID treatment rates, increasing case-finding can be cost-effective in specialist addiction services, and in prisons if continuity of treatment/care is ensured.
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Affiliation(s)
- Natasha K Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alec Miners
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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