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Ibraheem MF, Kareem FH. The impact of sofosbuvir/ledipasvir on chronic hepatitis C-infected paediatric patients: a Middle East single-centre experience. PRZEGLAD GASTROENTEROLOGICZNY 2023; 18:437-441. [PMID: 38572458 PMCID: PMC10985745 DOI: 10.5114/pg.2023.132462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/22/2022] [Indexed: 04/05/2024]
Abstract
Introduction Direct-acting antiviral (DAA) regimens were approved in 2013 with a response rate exceeding 95% and minimal side effects. The response rate of sofosbuvir and ledipasvir exceeds 95% with minimal side effects. Aim To identify the effects of this regimen in the eradication of viruses from the patients.Material and methods: A prospective observational, open-label study took place between July 2018 and September 2020. The study included 37 patients, about two-thirds of them were male 23 (62.16%), while females comprised 14 (37.84%). All patients received a combination of sofosbuvir 400 mg and ledipasvir 90 mg in a single oral daily dose according to their weight. Results The most common HCV genotype was HCV-4, followed by HCV-1 and HCV-2. And by comparing parameters at baseline, end of the treatment, and 12 weeks after completing the treatment, the laboratory data revealed dramatic drops of all liver function tests, the mean of alanine aminotransferase (ALT) (31.1 ±1.42 IU/l vs. 95.5 ±23.16, p < 0.05), aspartate aminotransferase (AST) (29.86 ±1.75 IU/l vs. 89.19 ±24.83, p < 0.05), total serum bilirubin (TSB) (0.57 ±0.07 mg/dl vs. 1.73 ±0.38 mg/dl, p < 0.05), mean HCV PCR (1605168 ±368223.72), after finishing the treatment course, and 12 weeks after that it was non-detectable (p < 0.05). Conclusions Treatment with dose-adjusted oral DAAs (SOF/LED) for 12 weeks was well tolerated in Iraqi children and adolescents infected with chronic HCV infections, with a high success rate and trivial adverse effects.
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Effectiveness of sofosbuvir/ledipasvir in hepatitis C virus infection in children and adolescents with malignancy: tertiary center experience. Clin Exp Hepatol 2022; 8:315-320. [PMID: 36683872 PMCID: PMC9850300 DOI: 10.5114/ceh.2022.122278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/23/2022] [Indexed: 12/31/2022] Open
Abstract
Aim of the study To determine the outcome of concomitant treatment of chronic hepatitis C virus (HCV) in children with malignant disease. Material and methods This was a prospective cohort study conducted at a gastroenterology and hepatology outpatient clinic in a children's welfare teaching hospital/medical city complex, Baghdad, from January 2018 to October 2020 and included 30 child and adolescent patients who contracted HCV while receiving treatment for malignant diseases. Data collected included those of medical history, physical examination, and periodic clinical and laboratory evaluation during their follow-up. Their age (at the time of diagnosis of HCV) ranged between 3.2 and 15.3 years, the mean age was 8.3 years, with male predominance of 60%. Results Sustained virologic response at post-treatment week 12 (SVR12) was obtained in all patients, 30/30 (100%), with gradual dramatic improvements of the liver enzymes, TSB, serum creatinine, and serum albumin. No serious side effects were registered, nor was there any treatment discontinuation or death. Tiredness was the most common side effect 10/30 (33.3%) in all patients. Conclusions A combination of the ledipasvir plus sofosbuvir regimen for 12 weeks is effective and well tolerated, and can be used safely in treating children older than 3 years and adolescent patients with chronic hepatitis C.
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Thompson LA, Fenton J, Charlton CL. HCV reflex testing: A single-sample, low-contamination method that improves the diagnostic efficiency of HCV testing among patients in Alberta, Canada. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:97-107. [PMID: 36337352 PMCID: PMC9608109 DOI: 10.3138/jammi-2021-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) can be cured with antiviral treatments. Diagnosis normally requires two blood samples, one for serology screening and one for molecular confirmation. This multi-step process creates barriers in patient care and decreases testing for hard-to-reach populations. We used the cobas® 6800 to detect HCV RNA after antibody testing to investigate whether a single-sample reflex testing method is effective and efficient for diagnosing HCV-positive patients. METHODS HCV RNA-positive clinical samples (n = 152) were interchangeably loaded on the ARCHITECT i2000SR with negative samples (n = 152) in a checkerboard fashion, tested for HCV antibodies using fixed probes, and directly transferred to the cobas 6800 for molecular testing. Contamination rates, sensitivity, and specificity were determined by comparing Abbott m2000 and cobas 6800 viral loads. After implementing reflex testing, clinical data over a 6-month period were analyzed for diagnostic efficiency. RESULTS Contamination was present in 5 of 152 pairs (3.29%) after reflex testing. Sensitivity and specificity were 99.3% (95% CI 95.1% to 99.9%) and 100% (95% CI 97.5% to 100%), respectively, using the cobas 6800 assay after serotesting. Approximately 97% of clinical patients received a conclusive test result with the reflex-testing algorithm. For HCV-positive patients, mean diagnostic turnaround times were significantly lower using reflex testing versus the two-sample method (4 versus 39 days; p < 0.0001). CONCLUSIONS HCV reflex testing demonstrated low levels of contamination without compromising the integrity of the molecular assay. Implementation in clinical laboratories would increase the efficiency of diagnosis and decrease steps in the continuum of care for patients.
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Affiliation(s)
- L Alexa Thompson
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jayne Fenton
- Alberta Precision Laboratories (ProvLab), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen L Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (ProvLab), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
- Li Ka Shing Institute of Virology, Edmonton, Alberta, Canada
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Sharma S, Thomas E, Caputi M, Asghar W. RT-LAMP-Based Molecular Diagnostic Set-Up for Rapid Hepatitis C Virus Testing. BIOSENSORS 2022; 12:298. [PMID: 35624599 PMCID: PMC9138684 DOI: 10.3390/bios12050298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Hepatitis C virus (HCV) infections occur in approximately 3% of the world population. The development of an enhanced and extensive-scale screening is required to accomplish the World Health Organization's (WHO) goal of eliminating HCV as a public health problem by 2030. However, standard testing methods are time-consuming, expensive, and challenging to deploy in remote and underdeveloped areas. Therefore, a cost-effective, rapid, and accurate point-of-care (POC) diagnostic test is needed to properly manage the disease and reduce the economic burden caused by high case numbers. Herein, we present a fully automated reverse-transcription loop-mediated isothermal amplification (RT-LAMP)-based molecular diagnostic set-up for rapid HCV detection. The set-up consists of an automated disposable microfluidic chip, a small surface heater, and a reusable magnetic actuation platform. The microfluidic chip contains multiple chambers in which the plasma sample is processed. The system utilizes SYBR green dye to detect the amplification product with the naked eye. The efficiency of the microfluidic chip was tested with human plasma samples spiked with HCV virions, and the limit of detection observed was 500 virions/mL within 45 min. The entire virus detection process was executed inside a uniquely designed, inexpensive, disposable, and self-driven microfluidic chip with high sensitivity and specificity.
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Affiliation(s)
- Sandhya Sharma
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA;
- Asghar-Lab: Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA
| | - Emmanuel Thomas
- Department of Microbiology and Immunology and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL 33136, USA;
| | - Massimo Caputi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Waseem Asghar
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA;
- Asghar-Lab: Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA
- Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL 33431, USA
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Marcellusi A, Mennini FS, Ruf M, Galli C, Aghemo A, Brunetto MR, Babudieri S, Craxi A, Andreoni M, Kondili LA. Optimizing diagnostic algorithms to advance Hepatitis C elimination in Italy: A cost effectiveness evaluation. Liver Int 2022; 42:26-37. [PMID: 34582627 PMCID: PMC9292516 DOI: 10.1111/liv.15070] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Optimized diagnostic algorithms to detect active infections are crucial to achieving HCV elimination. We evaluated the cost effectiveness and sustainability of different algorithms for HCV active infection diagnosis, in a context of a high endemic country for HCV infection. METHODS A Markov disease progression model, simulating six diagnostic algorithms in the birth cohort 1969-1989 over a 10-year horizon from a healthcare perspective was used. Conventionally diagnosis of active HCV infection is through detection of antibodies (HCV-Ab) detection followed by HCV-RNA or HCV core antigen (HCV-Ag) confirmatory testing either on a second sample or by same sample reflex testing. The undiagnosed and unconfirmed rates were evaluated by assays false negative estimates and each algorithm patients' drop-off. Age, liver disease stages distribution, liver disease stage costs, treatment effectiveness and costs were used to evaluate the quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratios (ICER). RESULTS The reference option was Rapid HCV-Ab followed by second sample HCV-Ag testing which produced the lowest QALYs (866,835 QALYs). The highest gains in health (QALYs=974,458) was obtained by HCV-RNA reflex testing which produced a high cost-effective ICER (€891/QALY). Reflex testing (same sample-single visit) vs two patients' visits algorithms, yielded the highest QALYs and high cost-effective ICERs (€566 and €635/QALY for HCV-Ag and HCV-RNA, respectively), confirmed in 99.9% of the 5,000 probabilistic simulations. CONCLUSIONS Our data confirm, by a cost effectiveness point of view, the EASL and WHO clinical practice guidelines recommending HCV reflex testing as most cost effective diagnostic option vs other diagnostic pathways.
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Affiliation(s)
- Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA)CEISFaculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
- Institute of Leadership and Management in HealthKingston Business SchoolKingston UniversityLondonUK
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA)CEISFaculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
- Institute of Leadership and Management in HealthKingston Business SchoolKingston UniversityLondonUK
| | - Murad Ruf
- Public Health, Medical AffairsGilead ScienceLondonUK
| | - Claudio Galli
- Global Medical and Scientific AffairsCore Laboratory, AbbottRomeItaly
| | - Alessio Aghemo
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly
- Division of Internal Medicine and HepatologyHumanitas Research Hospital IRCCSRozzanoItaly
| | - Maurizia R. Brunetto
- Internal MedicineDepartment of Clinical and Experimental MedicineUniversity of PisaPisaItaly
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis VirusesUniversity Hospital of PisaPisaItaly
| | - Sergio Babudieri
- Infectious and Tropical Disease UnitDepartment of MedicalSurgical and Experimental SciencesUniversity of SassariSassariItaly
| | - Antonio Craxi
- Gastroenterology and Hepatology UnitDepartment of Internal Medicine and Medical Specialties “PROMISE”University of PalermoPalermoItaly
| | - Massimo Andreoni
- Department of Systems MedicineUniversity of Rome “Tor Vergata”RomeItaly
- Infectious Diseases ClinicUniversity Hospital “Tor Vergata”RomeItaly
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Bushman ET, Subramani L, Sanjanwala A, Dionne-Odom J, Franco R, Owen J, Subramaniam A. Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care. Am J Perinatol 2021; 38:1109-1116. [PMID: 33934324 DOI: 10.1055/s-0041-1728827] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Despite the Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) recommending universal hepatitis C virus (HCV) screening in pregnancy Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) continue to endorse risk-based screening for HCV in pregnancy. We hypothesized that universal screening is associated with increased HCV diagnosis and postpartum linkage to HCV care compared with risk-based screening. STUDY DESIGN This retrospective cohort study included pregnant women screened for HCV at a single tertiary-care center. We defined two cohorts: women managed with risk-based (January 2014-October 2016) or universal HCV screening (November 2016-December 2018). Screening was performed with ELISA antibody testing and viremia confirmed with HCV ribonucleic acid (RNA) polymerase chain reaction (PCR). Primary outcomes were the rate of HCV screen positivity and postpartum linkage to care. RESULTS From 2014 to 2018, 16,489 women delivered at our institution, of whom 166 screened positive for HCV. A total of 7,039 pregnant women were screened for HCV: 266 with risk-based and 6,773 with universal screening; 29% (76/266) were positive HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (90/6,773) in the universal cohort. HCVAb+ women in the risk-based cohort were more likely to have a positive drug screen. Only 69% (62/90) of HCVAb+ women in the universal cohort met the criteria for risk-based testing. Of the remaining 28 women, 6 (21%) had active viremia (HCV RNA+). Of the 166 HCVAb+ women, 64% (103/166) were HCV RNA+-51 of 266 (19%) in the risk-based and 52 of 6,773 (0.8%) in the universal cohort. Of HCVAb+ women, 75% (125/166) were referred postpartum for HCV evaluation and 27% (34/125) were linked to care. Only 9% (10/103) of women with viremia initiated treatment within 1 year of delivery. CONCLUSION Universal HCV screening in pregnancy identified an additional 31% of HCVAb+ women compared with risk-based screening. Given low rates of HCV follow-up and treatment regardless of screening modality, further studies are needed to address barriers to postpartum linkage to care. KEY POINTS · Ideal screening for HCV in pregnancy is unknown.. · We explore screening strategies in pregnancy to linkage to HCV care.. · Regardless of screening strategy there is low rates of postpartum linkage to HCV care..
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Affiliation(s)
- Elisa T Bushman
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lakshmi Subramani
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Aalok Sanjanwala
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jodie Dionne-Odom
- Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Ricardo Franco
- Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - John Owen
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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7
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Comparative evaluation of Elecsys, Atellica, and Alinity assays for measuring the anti-Hepatitis C virus (HCV) antibody. J Clin Virol 2021; 141:104910. [PMID: 34273861 DOI: 10.1016/j.jcv.2021.104910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major cause of liver diseases in Korea. Anti-HCV assays are used to screen for HCV infection. Here, we assessed the agreement and diagnostic performances of three different anti-HCV assays. METHODS We analyzed 1180 samples using three assay systems-Elecsys Anti-HCV II (Roche Diagnostics), Atellica IM aHCV (Siemens Healthineers), and Alinity s Anti-HCV (Abbott Diagnostics)-and evaluated the agreements between the results and diagnostic performances. RESULTS The Cohens kappa coefficients between the Roche and Siemens, Siemens and Abbott, and Roche and Abbott systems were 0.837, 0.961, and 0.849, respectively. The Fleiss kappa coefficient among the three systems was 0.883. The sensitivities and positive predictive values were 86.5 and 89.8 for Roche, 97.5 and 98.1 for Siemens, and 99.4 and 98.2 for Abbott, respectively. The area under the curves of the anti-HCV signal to cutoff (S/Co) ratios or cutoff index for predicting viremia in the Roche, Siemens, and Abbott systems were 0.432, 0.641, and 0.676, respectively; the optimal S/Co ratio was 14.715 for Siemens and 14.42 for Abbott. CONCLUSIONS All three assays showed excellent diagnostic performance; however, anti-HCV values need to be used with caution to predict viremia; therefore, supplementary tests are necessary to confirm viremia status, especially for samples with low values.
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8
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Agbim U, Cseprekal O, Yazawa M, Talwar M, Balaraman V, Bhalla A, Podila PSB, Maliakkal B, Nair S, Eason JD, Molnar MZ. Factors associated with hepatitis C antibody seroconversion after transplantation of kidneys from hepatitis C infected donors to hepatitis C naïve recipients. Ren Fail 2021; 42:767-775. [PMID: 32729359 PMCID: PMC7472509 DOI: 10.1080/0886022x.2020.1798784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background We aimed to assess the probability and factors associated with the presence of hepatitis C virus (HCV) antibody among HCV seronegative kidney transplant recipients receiving HCV-infected (nucleic acid testing positive) donor kidneys. Methods This is a retrospective review examining HCV antibody seroconversion of all kidney transplant recipients receiving an organ from an HCV-infected donor between 1 March 2018 and 2 December 2019 at a high-volume kidney transplant center in the southeast United States. Results Of 97 patients receiving HCV-infected kidneys, the final cohort consisted of 85 recipients with 5 (5.9%) recipients noted to have HCV antibody seroconversion in the setting of HCV viremia. The HCV RNA level at closest time of antibody measurement was higher in the seroconverted patients versus the ones who never converted [median and (interquartile range): 1,091,500 (345,000–8,360,000) vs 71,500 (73–313,000), p = 0.02]. No other significant differences including type of immunosuppression were noted between the HCV antibody positive group and HCV antibody negative group. Donor donation after cardiac death status [Odds Ratio (OR) and 95% Confidence Interval (CI) was: 8.22 (1.14–59.14)], donor age [OR (95% CI) (+5 years) was: 3.19 (1.39–7.29)] and Kidney Donor Profile Index [OR (95% CI) (+1) was:1.07 (1.01–1.15)] showed a statistically significant association with HCV seroconversion. Conclusions HCV antibody should not be considered routine screening for presence of infection in previously HCV naïve kidney transplant recipients receiving kidneys from HCV-infected donors, as only a modest percentage have antibody despite active viremia. The assessment of HCV viral load should be routine in all transplant recipients receiving organs from public health service increased risk donors.
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Affiliation(s)
- Uchenna Agbim
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
| | - Orsolya Cseprekal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Masahiko Yazawa
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Tokyo, Japan
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pradeep S B Podila
- Faith and Health Division, Methodist Le Bonheur Healthcare, Memphis, TN, USA.,Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Benedict Maliakkal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satheesh Nair
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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9
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Jülicher P, O'Kane M, Price CP, Christenson R, John AS. Health economic evaluations of medical tests: Translating laboratory information into value - A case study example. Ann Clin Biochem 2021; 59:23-36. [PMID: 33874738 DOI: 10.1177/00045632211013852] [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] [Indexed: 11/15/2022]
Abstract
Health-care providers and funders are focused on identifying value in all their services and that includes laboratories. This means that in order to gain a share of scarce resources, laboratory professionals must also understand and assess the value of tests and that includes their economic impact. This can be assessed using health economic modelling tools which, when used in conjunction with a detailed value proposition for the test, can translate laboratory information into value. While a variety of health economic assessment tools are available, this review will focus on the use of decision analytic models which essentially compare the outcomes from pathways with and without the new test, the value of which is being assessed. A step-by-step framework is provided to guide laboratory professionals through the essential steps of conducting the evaluation. Initial steps include mapping the clinical pathway, understanding the goal of the evaluation, identifying the key stakeholders and their needs and determining a suitable analytical model. Following collection of the actual data, the validity of the model must be checked, and the robustness of the outcomes tested through sensitivity analysis. The last step is to translate the findings into measures of value which can then inform appropriate decisions by the stakeholders. This review of basic health economic modelling should enable laboratory professionals to have an understanding of how modelling can be applied to tests in their own environment and help deliver their potential value.
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Affiliation(s)
- Paul Jülicher
- Health Economics and Outcomes Research, Medical Affairs, Abbott Laboratories, Wiesbaden, Germany
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Londonderry, UK
- Centre for Personalised Medicine: Clinical Decision Making and Patient Safety, C-TRIC, Altnagelvin Hospital, Londonderry, UK
| | - Christopher P Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert Christenson
- Laboratories of Pathology, University of Maryland Medical Centre, Baltimore, MD, USA
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Hujoel IA, Jansson-Knodell CL, Hujoel PP, Hujoel MLA, Choung RS, Murray JA, Rubio-Tapia A. Estimating the Impact of Verification Bias on Celiac Disease Testing. J Clin Gastroenterol 2021; 55:327-334. [PMID: 32433257 PMCID: PMC7674196 DOI: 10.1097/mcg.0000000000001361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023]
Abstract
GOAL The goal of this study was to estimate the impact of verification bias on the diagnostic accuracy of immunoglobulin A tissue transglutaminase (IgA tTG) in detecting celiac disease as reported by an authoritative meta-analysis, the 2016 Comparative Effectiveness Review (CER). BACKGROUND Verification bias is introduced to diagnostic accuracy studies when screening test results impact the decision to verify disease status. MATERIALS AND METHODS We adjusted the sensitivity and specificity of IgA tTG reported by the 2016 CER with the proportion of IgA tTG positive and negative individuals who are referred for confirmatory small bowel biopsy. We performed a systematic review from January 1, 2007, to July 19, 2017, to determine these referral rates. RESULTS The systematic review identified 793 articles of which 9 met inclusion criteria (n=36,477). Overall, 3.6% [95% confidence interval (CI): 1.1%-10.9%] of IgA tTG negative and 79.2.2% (95% CI: 65.0%-88.7%) of IgA tTG positive individuals were referred for biopsy. Adjusting for these referral rates the 2016 CER reported sensitivity of IgA tTG dropped from 92.6% (95% CI: 90.2%-94.5%) to 57.1% (95% CI: 35.4%-76.4%) and the specificity increased from 97.6% (95% CI: 96.3%-98.5%) to 99.6% (95% CI: 98.4%-99.9%). CONCLUSIONS The CER may have largely overestimated the sensitivity of IgA tTG due to a failure to account for verification bias. These findings suggest caution in the interpretation of a negative IgA tTG to rule out celiac disease in clinical practice. More broadly, they highlight the impact of verification bias on diagnostic accuracy estimates and suggest that studies at risk for this bias be excluded from systematic reviews.
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Affiliation(s)
- Isabel A. Hujoel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905
| | | | - Philippe P. Hujoel
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195
| | - Margaux L. A. Hujoel
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905
| | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905
| | - Alberto Rubio-Tapia
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, 44103
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11
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Eijsink JFH, Al Khayat MNMT, Boersma C, Ter Horst PGJ, Wilschut JC, Postma MJ. Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:75-88. [PMID: 33064259 PMCID: PMC7561704 DOI: 10.1007/s10198-020-01236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. We assessed the impact of HCV screening and subsequent treatment with new direct-acting antivirals (DAAs) among pregnant women in the Netherlands. METHODS An HCV natural history Markov transition state model was developed, to evaluate the public-health and economic impact of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled 3 further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios: i no intervention, i.e., the current practice, ii screen-and-treat, i.e., the most extensive approach involving treatment of all individuals found HCV-positive, and iii screen-and-treat/monitor, i.e., a strategy involving treatment of symptomatic (F1-F4) patients and follow-up of asymptomatic (F0) HCV carriers with subsequent treatment only at progression. RESULTS For all cohorts, comparison between scenarios (ii) and (i) resulted in ICERs between €9,306 and €10,173 per QALY gained and 5 year budget impacts varying between €6,283,830 and €19,220,405. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,739 and €2,749 per QALY gained and budget impacts varying between €1,468,670 and €5,607,556. For all cohorts, the ICERs (scenario iii versus ii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between €56,607 and €56,892, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained and even above a threshold of €50,000 per QALY gained. CONCLUSION Universal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention.
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Affiliation(s)
- Job F H Eijsink
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, The Netherlands.
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Clinical Pharmacy, Isala, Zwolle, The Netherlands.
| | - Mohamed N M T Al Khayat
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis Boersma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sadeghimehr M, Bertisch B, Schaetti C, Wandeler G, Richard JL, Scheidegger C, Keiser O, Estill J. Modelling the impact of different testing strategies for HCV infection in Switzerland. J Virus Erad 2019; 5:191-203. [PMID: 31754442 PMCID: PMC6844406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Hepatitis C virus (HCV) infection is a major cause of liver disease. Since symptoms of chronic liver disease usually appear only late in the course of the disease, infected individuals may remain undiagnosed until advanced disease has developed. We aimed to investigate which screening strategies would be most effective to detect individuals unaware of their infection. METHODS We developed a mathematical model for HCV disease progression and compared the current practice of HCV testing in Switzerland with the following screening strategies: intensive screening of active injection drug users (IDU), screening of former IDU, screening of individuals originating from countries with high HCV prevalence, screening of individuals born 1951-1985 (birth-cohort) and universal screening. All screening interventions were considered in addition to a baseline scenario that reflected the current practice of HCV testing. RESULTS Within the first 4 years (2018-2021), every year, on average 650 cases were diagnosed in the baseline scenario, 660 with intensified IDU screening, 760 with former IDU screening, 830 with origin-based screening, 1420 with birth-cohort screening and 1940 with universal screening. No difference in liver-related mortality and incidence of end-stage liver disease between the screening scenarios was observed. CONCLUSION Our results suggest that only large-scale screening of the general population could substantially accelerate the rate of HCV diagnosis and treatment in Switzerland and other countries with similar epidemics. However, this implies screening of a large population with low prevalence, and may trigger considerable numbers of false-positive and borderline test results.
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Affiliation(s)
- Maryam Sadeghimehr
- Institute of Global Health,
University of Geneva,
Geneva,
Switzerland,Corresponding author: Maryam Sadeghimehr
Institute of Global Health,
University of Geneva,
9 Chemin des Mines,
1202Geneva,
Switzerland
| | - Barbara Bertisch
- Institute of Global Health,
University of Geneva,
Geneva,
Switzerland
| | - Christian Schaetti
- Federal Office of Public Health,
Public Health Directorate,
Bern,
Switzerland
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine,
University of Bern,
Bern,
Switzerland,Department of Infectious Diseases,
Bern University Hospital,
University of Bern,
Switzerland
| | - Jean-Luc Richard
- Federal Office of Public Health,
Public Health Directorate,
Bern,
Switzerland
| | | | - Olivia Keiser
- Institute of Global Health,
University of Geneva,
Geneva,
Switzerland
| | - Janne Estill
- Institute of Global Health,
University of Geneva,
Geneva,
Switzerland,Institute of Mathematical Statistics and Actuarial Science,
University of Bern,
Bern,
Switzerland,Alternative corresponding author: Janne Estill
Institute of Global Health,
University of Geneva,
9 Chemin des Mines,
1202Geneva,
Switzerland
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Sadeghimehr M, Bertisch B, Schaetti C, Wandeler G, Richard JL, Scheidegger C, Keiser O, Estill J. Modelling the impact of different testing strategies for HCV infection in Switzerland. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30036-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Jülicher P, Chulanov VP, Pimenov NN, Chirkova E, Yankina A, Galli C. Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis. PLoS One 2019; 14:e0219687. [PMID: 31310636 PMCID: PMC6634401 DOI: 10.1371/journal.pone.0219687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/29/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Screening for hepatitis C in Russia is a complex process that involves several visits and stepwise testing, limiting adherence and substantially reducing the yield in the identification of active infections. We aimed to evaluate the cost-effectiveness of different screening algorithms from a health system perspective. METHODS A decision analytic model was applied to a hypothetical adult population eligible to participate in a general screening program for hepatitis C in Russia. The standard pathway (I: Screen for anti-HCV antibodies followed by a nucleic acid test for HCV RNA on antibody positives) was compared to three alternatives (II: Screen for antibodies, a reflexed test for HCV antigen on antibody positives, and RNA on antigen negatives; III: Screen for antibodies, a reflexed test for HCV antigen on antibody positives; IV: Screen for antigen). Each strategy considered a cascade of events (referral, adherence, testing, diagnosis) that must occur for screening to be effective. The primary measure of effectiveness was the number of diagnosed active infections. Calculations followed a health system perspective with costs derived from 2017 reimbursement rates and a willingness-to-pay of 2,000RUB ($82) per diagnosed active infection. Model was tested with deterministic and probabilistic sensitivity analyses. RESULTS Non-adherence to screening stages reduced the capture rate of active infections in Strategy I from 79.0% to 40.6%. Strategies II, III, and IV were less affected and identified 69%, 67%, and 104% more infections. Average costs per diagnosed infection were decreased by 41% from 89,599RUB ($3,681) for I to 53,072RUB ($2,180), 53,004RUB ($2,177), and 59,633RUB ($2,450) for II, III, and IV, respectively. With a probability of 97%, Strategy III was most cost-effective with an incremental cost-effectiveness ratio vs. I of -1,373RUB (CI: -5,011RUB to -2,033RUB; $-56; CI: -$206 to -$84). Below a willingness-to-pay of 91,000RUB ($3,738), Strategy IV was not cost-effective. Sensitivity analyses confirmed the robustness of results. CONCLUSIONS Testing strategies for hepatitis C with HCV antigen on HCV antibody positive cases offer a streamlining opportunity for population screening programs. Those shall increase the chances for detecting active infections and are cost-effective over current practice in Russia.
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Affiliation(s)
- Paul Jülicher
- Health Economics and Outcomes Research, Abbott Diagnostics, Wiesbaden, Germany
- * E-mail:
| | - Vladimir P. Chulanov
- Reference Center for Viral Hepatitis, Central Research Institute of Epidemiology, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Nikolay N. Pimenov
- Reference Center for Viral Hepatitis, Central Research Institute of Epidemiology, Moscow, Russia
| | - Ekaterina Chirkova
- Reference Center for Viral Hepatitis, Central Research Institute of Epidemiology, Moscow, Russia
| | - Anna Yankina
- Medical Communication, Abbott Diagnostics, Khimki, Russia
- CIS, Moscow, Russia
| | - Claudio Galli
- Global Medical & Scientific Affairs, Abbott Diagnostics, Rome, Italy
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Yue ZH, Xia CS, Wang H. Performance evaluation of the mindray anti-HCV assay for the detection of hepatitis C virus infection. J Clin Lab Anal 2018; 32:e22600. [PMID: 30058207 DOI: 10.1002/jcla.22600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/05/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Anti-hepatitis C virus (anti-HCV) antibody assays are recommended for HCV infection screening. The Mindray anti-HCV assay, based on a third-generation immunoassay, was recently launched in China. We aimed to evaluate its diagnostic performance compared with that of two other widely used assays. METHODS Six HCV infection seroconversion panels were used to evaluate the sensitivity of the assay for early detection. A total of 1952 clinical samples were tested by the Mindray anti-HCV, Elecsys anti-HCV II, and Architect anti-HCV assays. Samples with reactive results using at least one anti-HCV assay were further tested with the recombinant immunoblot assay (RIBA). Inconsistent results were investigated by the HCV RNA assay and HCV core antigen assay. HCV infection diagnosis was made according to the results of laboratory tests and medical records. RESULTS The Mindray anti-HCV assay and Elecsys anti-HCV II assay detected seroconversion in an average of 12.5 days and 10.5 days, respectively, and this difference was not significant (P = .818). Of the 1952 cases, 90 were categorized as "HCV infection" and 1862 were categorized as "no HCV infection." The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of each assay were as follows: the Mindray anti-HCV assay, 95.6%, 99.2%, 85.1%, 99.8%, 118.6 and 0.045, respectively; the Architect anti-HCV assay, 98.9%, 95.2%, 50.0%, 99.9%, 20.69 and 0.012, respectively; and the Elecsys anti-HCV II assay, 96.7%, 99.9%, 98.9%, 99.8%, 1799.9 and 0.033, respectively. There were significant differences in the specificity, PPV and LR+ among the three assays (P < .001). There were no significant differences in the sensitivity, NPV or LR- among the three assays (P > .05). CONCLUSIONS The Mindray anti-HCV assay displays a similar sensitivity to the Elecsys anti-HCV II assay with respect to the early detection of HCV infection. The Mindray anti-HCV assay shows excellent diagnostic performance and is suitable for the screening of HCV infection.
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Affiliation(s)
- Zhi-Hong Yue
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chang-Sheng Xia
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
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Cadieux G, Sachdeva H. Toward ending hepatitis C virus infection: What are the next steps? CMAJ 2017; 189:E583-E584. [PMID: 28438950 DOI: 10.1503/cmaj.170274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Geneviève Cadieux
- Dalla Lana School of Public Health (Cadieux, Sachdeva), University of Toronto; Toronto Public Health (Sachdeva), Communicable Disease Control, Toronto, Ont.
| | - Herveen Sachdeva
- Dalla Lana School of Public Health (Cadieux, Sachdeva), University of Toronto; Toronto Public Health (Sachdeva), Communicable Disease Control, Toronto, Ont
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