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Epstein RL, Pramanick T, Baptiste D, Buzzee B, Reese PP, Linas BP, Sawinski D. A Microsimulation Study of the Cost-Effectiveness of Hepatitis C Virus Screening Frequencies in Hemodialysis Centers. J Am Soc Nephrol 2023; 34:205-219. [PMID: 36735375 PMCID: PMC10103100 DOI: 10.1681/asn.2022030245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND National guidelines recommend twice-yearly hepatitis C virus (HCV) screening for patients receiving in-center hemodialysis. However, studies examining the cost-effectiveness of HCV screening methods or frequencies are lacking. METHODS We populated an HCV screening, treatment, and disease microsimulation model with a cohort representative of the US in-center hemodialysis population. Clinical outcomes, costs, and cost-effectiveness of the Kidney Disease Improving Global Outcomes (KDIGO) 2018 guidelines-endorsed HCV screening frequency (every 6 months) were compared with less frequent periodic screening (yearly, every 2 years), screening only at hemodialysis initiation, and no screening. We estimated expected quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) between each screening strategy and the next less expensive alternative strategy, from a health care sector perspective, in 2019 US dollars. For each strategy, we modeled an HCV outbreak occurring in 1% of centers. In sensitivity analyses, we varied mortality, linkage to HCV cure, screening method (ribonucleic acid versus antibody testing), test sensitivity, HCV infection rates, and outbreak frequencies. RESULTS Screening only at hemodialysis initiation yielded HCV cure rates of 79%, with an ICER of $82,739 per QALY saved compared with no testing. Compared with screening at hemodialysis entry only, screening every 2 years increased cure rates to 88% and decreased liver-related deaths by 52%, with an ICER of $140,193. Screening every 6 months had an ICER of $934,757; in sensitivity analyses using a willingness-to-pay threshold of $150,000 per QALY gained, screening every 6 months was never cost-effective. CONCLUSIONS The KDIGO-recommended HCV screening interval (every 6 months) does not seem to be a cost-effective use of health care resources, suggesting that re-evaluation of less-frequent screening strategies should be considered.
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Affiliation(s)
- Rachel L. Epstein
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | | | - Dimitri Baptiste
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Benjamin Buzzee
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Peter P. Reese
- Department of Medicine, Renal-Electrolyte Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin P. Linas
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Deirdre Sawinski
- Department of Nephrology and Transplantation, Weill Cornell College of Medicine, New York, New York
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Hanif FM, Majid Z, Luck NH, Tasneem AA, Laeeq SM, Mubarak M. Revolution in the diagnosis and management of hepatitis C virus infection in current era. World J Hepatol 2022; 14:647-669. [PMID: 35646260 PMCID: PMC9099099 DOI: 10.4254/wjh.v14.i4.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/05/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection is a major global public health problem, particularly in developing part of the world. Significant advances have been made in the early diagnosis and treatment of the disease. Its management has been particularly revolutionized during the past two decades. In this review, we summarize the major advances in the diagnostic and management armamentarium for chronic HCV infection. The focus of the present review is on the newer directly acting anti-viral agents, which have revolutionized the management of chronic HCV infection. Management of uncomplicated chronic HCV infection and of specific complications and special at-risk populations of patients will be covered in detail. Despite the advent and approval of highly effective and well tolerable oral agents, still many challenges remain, particularly the affordability, the equitable distribution and access to later drugs. The World Health Organization aims to eliminate viral hepatitis including HCV by 2030 since its poses a major public health threat. There is an urgent need to ensure uniform and early access to diagnostic and therapeutic facilities throughout the world if the later goal has to be realized.
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Affiliation(s)
- Farina M Hanif
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Zain Majid
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Syed Muddasir Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
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Ye S, Chen Y, Lou X, Ye X, Yang X. Association of macrophage inhibitory factor -1 polymorphisms with antiviral efficacy of type 1b chronic hepatitis C. Mol Cell Biochem 2021; 476:2439-2447. [PMID: 33604810 PMCID: PMC8119258 DOI: 10.1007/s11010-021-04097-2] [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] [Received: 09/02/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
The expression of macrophage inhibitory factor-1 (MIC-1) increases in patients with chronic hepatitis C (CHC), but whether MIC-1 level and its polymorphism affect the antiviral efficacy of CHC has not yet been reported. The present study aimed to investigate the association between MIC-1 polymorphism and antiviral efficacy in patients with CHC genotype 1b (CHC 1b). A total of 171 patients with CHC1b were recruited. The polymorphisms of rs1059369 and rs1059519 in MIC-1 were detected by DNA sequencing. All patients received a standard dose of polyethylene glycol interferon + ribavirin (PR regimen), and divided into response, nonresponse, sustained virological response (SVR), and non-sustained virological response (NSVR) groups based on HCV RNA levels. The genotype distribution of the two single nucleotide polymorphisms (SNPs) did not differ between the response and nonresponse groups, SVR and non-SVR groups. However, the level of MIC-1 was positively correlated with ALT, AST, PIIINP, CIV, and HCV RNA (P < 0.05). Compared to before treatment, the level of MIC-1 in plasma was significantly decrease in the response group but not in the non-responsive group. Our results suggest that the level of MIC-1 in CHC1b is correlated with liver cell injury, liver fibrosis index, and viral load. However, the polymorphism of rs1059369 and rs1059519 may have negligible impact in expression of MIC-1 and efficacy of antiviral therapy in CHC patient.
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Affiliation(s)
- Songdao Ye
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao Chen
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoting Lou
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xuanmei Ye
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xunjun Yang
- Department of Laboratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Konstantinidou EI, Kontekaki EG, Kefas A, Konstantinidis T, Romanidou G, Fotiadou E, Rekari V, Triantafyllidou E, Zisaki S, Kasmeridou E, Andreadou M, Kantartzi K, Mavromatidis K, Martinis G, Cassimos D, Thodis E, Panopoulou M, Mimidis K. The prevalence of HCV RNA positivity in anti-HCV antibodies-negative hemodialysis patients in Thrace Region. Multicentral study. Germs 2021; 11:52-58. [PMID: 33898341 DOI: 10.18683/germs.2021.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/05/2020] [Accepted: 01/12/2021] [Indexed: 01/18/2023]
Abstract
Introduction HCV infection in patients under hemodialysis for end stage chronic kidney disease (ESCKD) may exist despite the absence of anti-HCV antibodies. Molecular methods are widely accepted as "gold standard" techniques for the detection of viral RNA. However, the molecular methods are more expensive in comparison to conventional methods and their replacement is not cost-effective. The aim of this study was to estimate the prevalence of HCV RNA positivity in anti-HCV negative hemodialysis patients and evaluate new diagnostic methods for the detection and the monitoring of hepatitis C in ESCKD patients. Methods The study was performed in four hospitals of Thrace region of Greece and 233 patients with no history of hepatitis C were enrolled. Measurement of anti-HCV antibodies and HCV core antigen was performed by microparticle chemiluminescence immunoassay. Molecular detection of viral RNA was performed by the real-time RT PCR. Results The mean age of the patients was 64.9 ± 23.3 years. HCV-Ag was positive in 2/233 patients (0.86%). Nevertheless, viral RNA was negative in those patients. Conclusions The results of the present study showed that the incidence of HCV-RNA in patients with negative anti-HCV Abs, in hemodialysis patients in Thrace region of Greece was negligible (0/233).
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Affiliation(s)
- Eleni I Konstantinidou
- MD, MSc in "Infectious Diseases - International Medicine, From Bench to Bedside", Democritus University of Thrace, Dragana Campus, 68100 Alexandroupolis, Greece
| | - Eftychia G Kontekaki
- MD, MSc in "Infectious Diseases - International Medicine, From Bench to Bedside", Democritus University of Thrace, Dragana Campus, 68100 Alexandroupolis, Greece, Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Aristidis Kefas
- MD, MSc in "Infectious Diseases - International Medicine, From Bench to Bedside", Democritus University of Thrace, Dragana Campus, 68100 Alexandroupolis, Greece
| | - Theocharis Konstantinidis
- MD, PhD, Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece, Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Gioulia Romanidou
- MD, General Hospital "Sismanoglio", Sismanoglou 45, 69133 Komotini, Greece
| | - Eleni Fotiadou
- Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Viki Rekari
- MD, General Hospital of Xanthi, Neapoli, 67100 Xanthi, Greece; General Hospital of Didimoticho, 25May, 141, 683 00 Didimoticho, Greece
| | | | - Stavroula Zisaki
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Evi Kasmeridou
- General Hospital "Sismanoglio", Sismanoglou 45, 69133 Komotini, Greece
| | - Mariana Andreadou
- MD, General Hospital "Sismanoglio", Sismanoglou 45, 69133 Komotini, Greece
| | - Konstantina Kantartzi
- MD, PhD, Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | | | - George Martinis
- MD, Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Dimitrios Cassimos
- MD, PhD, Democritus University of Thrace, Pediatric Department, Alexandroupolis Greece
| | - Elias Thodis
- MD, PhD, Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Maria Panopoulou
- MD, PhD, Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Konstantinos Mimidis
- MD, PhD, First Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis
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