scholarly journals 312. Treatment of Hepatitis C After Identification of Infection During Universal Screening Approach in Pregnant Women

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S166-S166
Author(s):  
Michelle Rose ◽  
John Allen Myers ◽  
Nicholas Ryan ◽  
Alissa Prince ◽  
Morgan Talbot ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Willingness To Pay ◽  
Pregnant Women ◽  
Universal Screening ◽  
Antiviral Agents ◽  
Linkage To Care ◽  
Cost Effective ◽  
Standard Of Care ◽  
Quality Adjusted Life Year ◽  
Additional Treatment

Abstract Background Identifying asymptomatic individuals with hepatitis C virus (HCV) infection is challenging. Pregnancy presents a unique opportunity to screen women for HCV and then link those positive to care. Universal screening in pregnant women, however, is not recommended by CDC or ACOG. Further, treatment with direct antiviral agents (DAAs) are not currently approved for pregnant women but are warranted following delivery and breastfeeding. We sought to compare treatment uptake before and after universal screening in pregnant women was implemented as the standard of care in our institution and then determine if universal screening leads to increased treatment after pregnancy. Methods A retrospective analysis of risk-based HCV screening in pregnant women was used for the first period (2014–2015) and a prospective design was used following 18 months of universal screening (2016–2017). Prenatal data were collected from all pregnant women that sought care at our institution in the prospective part of the study. We tested for differences in relevant outcomes (e.g., screening rates, rate of those eligible for treatment, and those who actually received treatment) between the two periods. Finally, we performed a cost-effective analysis of universal screening considering treatment rates. Results During the universal screening period, more women were screened for HCV and diagnosed with chronic infection. Universal screening was not associated with a significant increase in the odds of women receiving treatment after pregnancy. The increased cost for universal screening was $1060 per patient, resulting in an ICER of $219,391 per additional treatment received or $57,734 per quality-adjusted life-year (QALY) gained, which is below the willingness-to-pay threshold to be cost-effective. Universal screening, however, is cost-effective with an ICER well below the established willingness-to-pay threshold of $100,000 per QALY gained, if all women eligible for treatment receive therapy. Conclusion Universal screening may not lead to a significant increase in the odds that pregnant women receive DAAs therapy after pregnancy. Barriers to linkage to care should be addressed in an effort to increase antiviral therapy for these women and universal screening should be implemented within this patient population. Disclosures All authors: No reported disclosures.

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

2021 ◽  
Author(s):  
Elisa T. Bushman ◽  
Lakshmi Subramani ◽  
Aalok Sanjanwala ◽  
Jodie Dionne-Odom ◽  
Ricardo Franco ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Pregnant Women ◽  
Universal Screening ◽  
Task Force ◽  
Care Center ◽  
Tertiary Care ◽  
Linkage To Care ◽  
Hcv Rna ◽  
Hcv Screening ◽  
In Pregnancy

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

scholarly journals Hepatitis C Variability, Patterns of Resistance, and Impact on Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Cristina Simona Strahotin ◽  
Michael Babich
Keyword(s):  
Hepatitis C ◽  
Antiviral Agents ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Resistance Mechanisms ◽  
Cost Effective Method ◽  
New Treatments ◽  
Cure Rates ◽  
Effective Treatments

Hepatitis C (HCV), a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma, is the most common indication for liver transplantation in the United States. Although annual incidence of infection has declined since the 1980s, aging of the currently infected population is expected to result in an increase in HCV burden. HCV is prone to develop resistance to antiviral drugs, and despite considerable efforts to understand the virus for effective treatments, our knowledge remains incomplete. This paper reviews HCV resistance mechanisms, the traditional treatment with and the new standard of care for hepatitis C treatment. Although these new treatments remain PEG-IFN-α- and ribavirin-based, they add one of the newly FDA approved direct antiviral agents, telaprevir or boceprevir. This new “triple therapy” has resulted in greater viral cure rates, although treatment failure remains a possibility. The future may belong to nucleoside/nucleotide analogues, non-nucleoside RNA-dependent RNA polymerase inhibitors, or cyclophilin inhibitors, and the treatment of HCV may ultimately parallel that of HIV. However, research should focus not only on effective treatments, but also on the development of a HCV vaccine, as this may prove to be the most cost-effective method of eradicating this disease.

scholarly journals The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

2018 ◽  
Vol 15 (9) ◽  
pp. 2013 ◽  
Author(s):  
Christina Greenaway ◽  
Iuliia Makarenko ◽  
Claire Abou Chakra ◽  
Balqis Alabdulkarim ◽  
Robin Christensen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis C ◽  
Lower Risk ◽  
Linkage To Care ◽  
Cost Effective ◽  
Screening Tests ◽  
European Economic Area ◽  
The European Union ◽  
Wide Range ◽  
The Eu

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

Inhibitory Effects of Amentoflavone and Orobol on Daclatasvir-Induced Resistance-Associated Variants of Hepatitis C Virus

2018 ◽  
Vol 46 (04) ◽  
pp. 835-852 ◽  
Author(s):  
Wei-Ping Lee ◽  
Keng-Li Lan ◽  
Shi-Xian Liao ◽  
Yi-Hsiang Huang ◽  
Ming-Chih Hou ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Viral Entry ◽  
Antiviral Agents ◽  
Cost Effective ◽  
Pegylated Interferon ◽  
Chinese Herbs ◽  
Inhibitory Effects ◽  
Direct Acting Antiviral ◽  
Direct Acting

Hepatitis C virus (HCV) is recognized as a major causative agent of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Despite rapid progress in the development of direct-acting antivirals (DAA) against HCV infection in recent years, cost-effective antiviral drugs with more affordable prices still need to be developed. In this study, we screened a library of natural compounds to identify natural HCV inhibitors. The library of the pure compounds extracted from Chinese herbs deposited in the chemical bank of National Research Institute of Chinese Medicine (NRICM), Taiwan was screened in the cell culture-derived HCV (HCVcc) system. We identified the flavone or flavan-based compounds amentoflavone, 7,4[Formula: see text]-dihydroxyflavanone, and orobol with the inhibition of viral entry, replication, and translation of the HCV life cycle. Amentoflavone and orobol also showed inhibitory effects on resistant-associated variants to the NS5A inhibitor daclatasvir. The results of this study have the potential to benefit patients who are intolerant to the adverse effect of pegylated interferon or who harbor resistant strains refractory to treatment by current direct-acting antiviral agents.

Hepatitis C Treatment Regimens Are Cost-Effective: But Compared With What?

2017 ◽  
Vol 51 (11) ◽  
pp. 961-969 ◽  
Author(s):  
T. Joseph Mattingly ◽  
Julia F. Slejko ◽  
C. Daniel Mullins
Keyword(s):  
Hepatitis C ◽  
Antiviral Agents ◽  
Cost Effective ◽  
Third Party ◽  
Health State ◽  
Genotype 4 ◽  
Treatment Regimens ◽  
Life Years ◽  
Primary Model ◽  
Lifetime Model

Background: Numerous economic models have been published evaluating treatment of chronic hepatitis C virus (HCV) infection, but none provide a comprehensive comparison among new antiviral agents. Objective: Evaluate the cost-effectiveness of all recommended therapies for treatment of genotypes 1 and 4 chronic HCV. Methods: Using data from clinical trials, observational analyses, and drug pricing databases, Markov decision models were developed for HCV genotypes 1 and 4 to compare all recommended drugs from the perspective of the third-party payer over a 5-, 10-, and 50-year time horizon. A probabilistic sensitivity analysis (PSA) was conducted by assigning distributions for clinical cure, age entering the model, costs for each health state, and quality-adjusted life years (QALYs) for each health state in a Monte Carlo simulation of 10 000 repetitions of the model. Results: In the lifetime model for genotype 1, effects ranged from 18.08 to 18.40 QALYs and total costs ranged from $88 107 to $184 636. The lifetime model of genotype 4 treatments had a range of effects from 18.23 to 18.43 QALYs and total costs ranging from $87 063 to $127 637. Grazoprevir/elbasvir was the optimal strategy followed by velpatasvir/sofosbuvir as the second-best strategy in most simulations for both genotypes 1 and 4, with drug costs and efficacy of grazoprevir/elbasvir as the primary model drivers. Conclusions: Grazoprevir/elbasvir was cost-effective compared with all strategies for genotypes 1 and 4. Effects for all strategies were similar with cost of drug in the initial year driving the results.

scholarly journals Universal Screening of Pregnant Women for Hepatitis C: The Time Is Now

2018 ◽  
Vol 67 (10) ◽  
pp. 1493-1497 ◽  
Author(s):  
Ravi Jhaveri ◽  
Tina Broder ◽  
Debika Bhattacharya ◽  
Marion G Peters ◽  
Arthur Y Kim ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Pregnant Women ◽  
Universal Screening ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Hcv Prevalence ◽  
Hcv Screening

Currently, risk-based hepatitis C virus (HCV) screening is recommended for women of childbearing age and pregnant women despite a high HCV prevalence. For many reasons outlined here, the time has come for universal screening for HCV for all pregnant women.

Cost-effectiveness of a supplementary class-based exercise program in the treatment of knee osteoarthritis

2006 ◽  
Vol 22 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Gerry Richardson ◽  
Neil Hawkins ◽  
Christopher James McCarthy ◽  
Pauline Mary Mills ◽  
Rachel Pullen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Exercise Program ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Current Evidence ◽  
Net Benefit ◽  
Unit Costs ◽  
Home Based ◽  
The Cost

Objectives:The aim of this study was to assess the cost-effectiveness of a class-based exercise program supplementing a home-based program when compared with a home-based program alone. In addition, we estimated the probability that the supplementary class program is cost-effective over a range of values of a decision maker's willingness to pay for an additional quality-adjusted life-year (QALY).Methods:The resource use and effectiveness data were collected as part of the clinical trial detailed elsewhere. Unit costs were estimated from published sources. The net benefit approach to cost-effectiveness analysis is used to estimate the probability of the intervention being cost-effective.Results:The addition of a supplementary class-based group results in an increase in QALYs and lower costs. For all plausible values of a decision maker's willingness to pay for a QALY, the supplementary class group is likely to be cost-effective.Conclusions:The addition of a class-based exercise program is likely to be cost-effective and, on current evidence, should be implemented.

scholarly journals Initiation of Hepatitis C treatment in two rural Rwandan districts: A mobile clinic approach

2020 ◽  
Author(s):  
Innocent Kamali ◽  
Dale Barnhart ◽  
Francoise Nyirahabihirwe ◽  
Jean de la Paix Gakuru ◽  
Mariam Uwase ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Mass Screening ◽  
Laboratory Tests ◽  
Treatment Initiation ◽  
Linkage To Care ◽  
Standard Of Care ◽  
Health Facilities ◽  
Mobile Clinic ◽  
Primary Level ◽  
The Cost

Abstract Background: To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing hepatitis C patients with free access to Direct Acting Antivirals (DAAs). Until 2020, all prescribers trained and authorized to initiate DAA treatment were based at District Hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We designed and implemented a mobile hepatitis clinic to provide DAA treatment initiation at primary-level health facilities among hepatitis C patients identified through mass screening campaigns in rural Kirehe and Kayonza districts. Methods: The mobile clinic team was composed of one clinician trained and authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.Results: Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with chronic hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD. Conclusion: The mobile clinic model was a feasible strategy for providing rapid treatment initiation among hepatitis C patients identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-center level.

scholarly journals Pegylated interferon-alfa plus ribavirin therapies for chronic hepatitis C

2011 ◽  
Vol 51 (181) ◽  
Author(s):  
T Kanda ◽  
O Yokosuka
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Antiviral Agents ◽  
Standard Of Care ◽  
Pegylated Interferon ◽  
New Drugs ◽  
Direct Acting Antiviral ◽  
New Information ◽  
Direct Acting

Until HCV NS3/4A protease inhibitors become available at the end of 2011, the combination pegylated-interferon (PEG-IFN)-alfa and ribavirin (RBV) will remain the standard treatment for chronic hepatitis C patients. In some hepatitis C virus-infected patients, PEG-IFN plus RBV treatment against HCV should continue to be used because of side effects of new drugs such as anemia. Our Japanese experiences should provide new information for the treatment of chronic hepatitis C.  Keywords: Direct-acting antiviral agents (DAA), HCV, pegylated interferon, ribavirin, standard of care (SOC ).

Targeted vs opportunistic screening for viral hepatitis among UK migrant communities: a cost-effectiveness analysis

2021 ◽  
Vol 27 (3) ◽  
pp. 90-98
Author(s):  
Harold A Salmon ◽  
Simon Briscoe ◽  
Graham R Foster ◽  
Martin A Pitt
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B ◽  
Willingness To Pay ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Ethnic Composition ◽  
World Health ◽  
Opportunistic Screening ◽  
Targeted Screening ◽  
Quality Adjusted Life

Worldwide eradication of chronic hepatitis B and C viruses by 2030 is a stated goal of the World Health Organization, UK government and the European Union. This study investigated the cost-effectiveness of targeted screening vs opportunistic screening for hepatitis B and C among migrant populations in the UK. Results of a previous clinical trial (HepFREE) carried out in London and Bradford were used to develop a combined decision tree and Markov simulation model. Despite a low response to invitations for vaccination, and a heterogeneous level of response between communities of different ethnic composition, this analysis shows that incentivised targeted screening is cost-effective at willingness-to-pay thresholds over £8540 per incremental quality-adjusted life year over a lifetime. Furthermore, probabilistic analysis of input parameter uncertainty suggests that the intervention has a greater than 95% probability of being cost-effective at willingness-to-pay thresholds under £30 000 per incremental quality-adjusted life year. These results strongly suggest that targeted screening should play a key part in the eradication of the hepatitis B and C viruses.

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