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 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.

scholarly journals Making Sense of Current and Emerging Therapies in Pancreatic Cancer: Balancing Benefit and Value

2015 ◽  
pp. e222-e227 ◽  
Author(s):  
Daniel H. Ahn ◽  
Andrew H. Ko ◽  
Neal J. Meropol ◽  
Tanios S. Bekaii-Saab
Keyword(s):  
Pancreatic Cancer ◽  
Standard Of Care ◽  
The United States ◽  
Economic Effects ◽  
Making Sense ◽  
Dismal Prognosis ◽  
Emerging Therapies ◽  
Metastatic Setting ◽  
Localized Disease ◽  
New Treatments

Pancreatic cancer remains the fourth leading cause of cancer deaths in the United States with a dismal prognosis and a 5-year survival of less than 5% across all stages.1In 2014, there were approximately 46,420 new cases of pancreatic cancer with only 9% of patients having localized disease.2Given that the vast majority of patients present with advanced disease, much of the focus for drug development has been in the metastatic setting, which is evident with the advent of two combination chemotherapy regimens for this indication. Although conventional cytotoxic chemotherapy remains the standard of care, an ongoing search for novel therapeutic approaches continues. We will highlight several new approaches here, with a particular emphasis on immunotherapeutic strategies. We will also introduce concepts regarding the potential economic effects associated with the development and implementation of new treatments in pancreatic cancer.

Risk of Transmission and Features of Hepatitis C After Needlestick Injuries

1999 ◽  
Vol 20 (01) ◽  
pp. 63-64 ◽  
Author(s):  
Saeed S. Hamid ◽  
Badar Farooqui ◽  
Qudsia Rizvi ◽  
Tarranum Sultana ◽  
Anwar A. Siddiqui
Keyword(s):  
Hepatitis C ◽  
Healthcare Workers ◽  
Cost Effective ◽  
Asymptomatic Infection ◽  
Needlestick Injury ◽  
Hcv Rna ◽  
Needlestick Injuries ◽  
Cost Effective Method ◽  
Polymerase Chain

Abstract The rate of transmission and management of needlestick injuries from hepatitis C virus (HCV) patients to healthcare workers is still a matter of debate. We used a stringent protocol using monthly transaminase levels and polymerase chain reaction for HCV RNA to monitor 53 healthcare workers prospectively for up to 6 months following needle injuries from HCV-positive patients. Evidence of transmission of HCV was found in only 2 workers (4%) with mild asymptomatic infection, one of which resolved spontaneously. Based on our experience, we now use a less-intensive follow-up protocol. Further investigation is required to determine the most cost-effective method to monitor individuals who suffer a needlestick injury from an HCV-positive patient.

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.

scholarly journals Clinical outcomes of patients after nipple-sparing mastectomy and reconstruction based on the expander/implant technique

Surgery Today ◽  
2020 ◽  
Author(s):  
Uhi Toh ◽  
Miki Takenaka ◽  
Nobutaka Iwakuma ◽  
Yoshito Akagi
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Gene Mutations ◽  
Cost Effective ◽  
Standard Of Care ◽  
Areolar Complex ◽  
Cost Effective Method ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Breast Reconstructive Surgery

AbstractAdvances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Compared with conventional breast construction followed by total mastectomy (TM), NSM preserving the nipple–areolar complex (NAC) with breast reconstruction provides psychosocial and aesthetic benefits, thereby improving patients’ cosmetic appearance and body image. Implant-based breast reconstruction (IBBR) has been used worldwide following mastectomy as a safe and cost-effective method of breast reconstruction. We review the clinical evidence about immediate (one-stage) and delayed (two-stage) IBBR after NSM. Our results suggest that the postoperative complication rate may be higher after NSM followed by IBBR than after TM or SSM followed by IBBR.

scholarly journals A Fast and Cost-Effective Method for Identifying a Polymorphism of Interleukin 28B Related to Hepatitis C

PLoS ONE ◽  
2013 ◽  
Vol 8 (10) ◽  
pp. e78142 ◽  
Author(s):  
Camila da Silva Ferreira ◽  
Rodrigo Martins Abreu ◽  
Marlone Cunha da Silva ◽  
Aline Siqueira Ferreira ◽  
Paulo Dominguez Nasser ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Cost Effective ◽  
Interleukin 28B ◽  
Cost Effective Method

What are the cure rates for the most effective treatments for chronic hepatitis C genotype 1 infections?

2020 ◽  
Vol 23 (8) ◽  
pp. 40-40
Author(s):  
Jill Marcus ◽  
Jose Elizondo
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Genotype 1 ◽  
Cure Rates ◽  
Effective Treatments

scholarly journals Precision Genomic Practice in Oncology: Pharmacist Role and Experience in an Ambulatory Care Clinic

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 32 ◽  
Author(s):  
Farah Raheem ◽  
Pauline Kim ◽  
Meagan Grove ◽  
Patrick J. Kiel
Keyword(s):  
Clinical Trial Design ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Tumor Board ◽  
Patient Specific ◽  
Cancer Center ◽  
Molecular Testing ◽  
Precision Oncology ◽  
Care Clinic

Recent advancements in molecular testing, the availability of cost-effective technology, and novel approaches to clinical trial design have facilitated the implementation of tumor genome sequencing into standard of care oncology practices. Current models of precision oncology practice include specialized clinics or consultation services based on a molecular tumor board (MTB) approach. MTBs are comprised of interprofessional teams of clinicians and scientists who evaluate tumors at the molecular level to guide patient-specific targeted therapy. The practice of precision oncology utilizing MTB-based models is an emerging approach, transforming precision genomics from a novel concept into clinical practice. This rapid shift in practice from cytotoxic therapy to targeted medicine poses challenges, yet brings exciting opportunities to clinical pharmacists practicing in hematology and oncology. Only a few precision genomics programs in the United States have a strong pharmacy presence with oncology pharmacists serving in leadership roles in research, interpreting genomic sequencing, making treatment recommendations, and facilitating off-label drug procurement. This article describes the experience of the precision medicine clinic at the Indiana University Health Simon Cancer Center, with emphasis on the role of the pharmacist in the precision oncology initiative.

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 Cost-Effectiveness of Olaratumab in Combination with Doxorubicin for Patients with Soft Tissue Sarcoma in the United States

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Santiago Zuluaga-Sanchez ◽  
Lisa M. Hess ◽  
Sorrel E. Wolowacz ◽  
Yulia D’yachkova ◽  
Emma Hawe ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Meta Analysis ◽  
Single Agent ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Life Years

Background. Standard first-line treatments for advanced soft tissue sarcoma (STS) have changed little for 40 years, and outcomes have been poor. Recently, the United States (US) Food and Drug Administration conditionally approved olaratumab in combination with doxorubicin (Olara + Dox) based on a randomized phase II trial that reported a significant 11.8-month improvement in median survival versus single-agent doxorubicin (Dox). The present study investigated the cost-effectiveness of Olara + Dox compared with Dox and five other standard-of-care regimens from the US payer perspective. Methods. An economic model was constructed to estimate costs and outcomes over patients’ lifetimes from start of therapy. Progression-free and overall survival were based on survival analysis of patient-level data and a meta-analysis. Adverse-event rates were based on trials. Costs were from published sources. Results. Olara + Dox resulted in an estimated additional 1.27 life-years (LYs) compared with Dox, with an increase in total expected lifetime costs of $133,653. The incremental cost-effectiveness ratio (ICER) was estimated at $105,408 per LY gained; in a fully incremental analysis, all other regimens were dominated (higher costs and lower LYs or a higher ICER). Conclusion. Olara + Dox is cost-effective for STS treatment compared with Dox and other standard-of-care regimens at willingness-to-pay thresholds of $150,000 per LY and above.

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