scholarly journals Motion – The Available Treatments for Hepatitis C Are Cost Effective: Arguments against the Motion

2002 ◽  
Vol 16 (10) ◽  
pp. 710-715 ◽  
Author(s):  
W Ray Kim
Keyword(s):  
Liver Disease ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
Natural History ◽  
Antiviral Therapy ◽  
Antiviral Agents ◽  
Cost Effective ◽  
Hcv Infection ◽  
Limited Effectiveness ◽  
History Of

Hepatitis C is a prevalent infection in North America. However, the natural history of hepatitis C virus (HCV) infection in the general population is not fully understood. Available cohortbased studies suggest that only a relative minority of patients develop significant liver disease, such as cirrhosis and/or hepatocellular carcinoma. Other studies, mostly conducted based on referral patients with established disease, portray much more serious consequences of HCV infection. Although a substantial improvement has been made in the treatment for HCV, the overall impact of antiviral therapy in altering the natural course of HCV infection remains uncertain. Therapeutic trials involve narrow selection criteria that would exclude the majority of hepatitis C patients in the community, and are conducted in ideal settings that may not be generalizable to the average practice setting. Demographic groups that are at high risk of developing severe liver disease include older male patients who consume alcohol. In contrast, antiviral therapy is more effective in young and female patients and those who do not drink alcohol. Thus, patients who appear to be successfully treated may not be those for whom clearance of the virus would be beneficial. Cost-effectiveness studies published to date have not been able to fully address the complex and heterogeneous matrix of the factors that influence the natural history of HCV infection and treatment response.In summary, there is a significant degree of uncertainty about many assumptions that are necessary in creating computer models to estimate the cost-effectiveness of HCV therapy. When interpreting the results of cost effectiveness analyses regarding the treatment of HCV infection, it is important to be aware of the underlying assumptions that are incorporated in the model and the data on which they are based. Given these limitations, vis-à-vis the expense, toxicity and yet limited effectiveness of the currently available antiviral agents, one should not blindly accept a conclusion that treatment for hepatitis C is cost effective.

Hepatitis C and HIV Co-Infection

2017 ◽  
Author(s):  
Jennifer Cohen Price ◽  
Priyanka Amin ◽  
Antoine Douaihy
Keyword(s):  
Hepatitis C ◽  
Natural History ◽  
The United States ◽  
Hcv Infection ◽  
Hepatic Decompensation ◽  
History Of ◽  
Chronic Hcv ◽  
Direct Acting ◽  
End Stage ◽  
Shared Risk

Chronic infection with hepatitis C virus (HCV) is a leading cause of end-stage liver disease and is the most common indication for liver transplantation in the United States. Because of shared risk factors, individuals living with HIV infection are disproportionately affected by HCV. Moreover, co-infection with HIV accelerates the natural history of chronic HCV infection, increasing the risk of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and death. Highly effective medications such as direct-acting antivirals (DAA) to cure HCV are now available and have the potential to profoundly improve the health of HIV-HCV-co-infected individuals. However, addressing the many gaps in the HCV care cascade is necessary to fully achieve the benefits of these drugs. This chapter reviews the natural history of HIV-HCV co-infection, the psychiatric comorbidities associated with HCV infection, the evolution of HCV treatment, and the barriers to care that HIV-HCV-co-infected individuals continue to face.

scholarly journals Risk Factors for Perinatal Transmission of Hepatitis C Virus (HCV) and the Natural History of HCV Infection Acquired in Infancy

2005 ◽  
Vol 192 (11) ◽  
pp. 1880-1889 ◽  
Author(s):  
Eric E. Mast ◽  
Lu‐Yu Hwang ◽  
Dexter S. Y. Seto ◽  
Frederick S. Nolte ◽  
Omana V. Nainan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Natural History ◽  
Perinatal Transmission ◽  
Hcv Infection ◽  
History Of

scholarly journals Treatment of HCV Infection in Children

2000 ◽  
Vol 14 (suppl b) ◽  
pp. 41B-44B ◽  
Author(s):  
Ruggiero Francavilla ◽  
Giorgina Mieli-Vergani
Keyword(s):  
Liver Disease ◽  
Natural History ◽  
Epidemiological Data ◽  
Hcv Infection ◽  
Western World ◽  
Common Cause ◽  
Number Of Children ◽  
History Of ◽  
Chronic Hcv Infection ◽  
Chronic Hcv

HepatitisCvirus (HCV) infection is the most common cause of chronic liver disease in the western world. Despite extensive epidemiological data in adults, the exact number of children infected is still unknown, and little is known about the natural history of chronic HCV infection in childhood. The authors review studies focusing onHCVinfection in children, and summarize the results, including the efficacy of interferon, and interferon plus ribavirin combination treatment of HCV hepatitis in childhood.

scholarly journals Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care

Thorax ◽  
2019 ◽  
Vol 74 (8) ◽  
pp. 730-739 ◽  
Author(s):  
Tosin Lambe ◽  
Peymane Adab ◽  
Rachel E Jordan ◽  
Alice Sitch ◽  
Alex Enocson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Natural History ◽  
Cost Effective ◽  
Case Finding ◽  
Base Case ◽  
Decision Analytic Model ◽  
Screening Questionnaire ◽  
History Of

Introduction‘One-off’ systematic case-finding for COPD using a respiratory screening questionnaire is more effective and cost-effective than routine care at identifying new cases. However, it is not known whether early diagnosis and treatment is beneficial in the longer term. We estimated the long-term cost-effectiveness of a regular case-finding programme in primary care.MethodsA Markov decision analytic model was developed to compare the cost-effectiveness of a 3-yearly systematic case-finding programme targeted to ever smokers aged ≥50 years with the current routine diagnostic process in UK primary care. Patient-level data on case-finding pathways was obtained from a large randomised controlled trial. Information on the natural history of COPD and treatment effects was obtained from a linked COPD cohort, UK primary care database and published literature. The discounted lifetime cost per quality-adjusted life-year (QALY) gained was calculated from a health service perspective.ResultsThe incremental cost-effectiveness ratio of systematic case-finding versus current care was £16 596 per additional QALY gained, with a 78% probability of cost-effectiveness at a £20 000 per QALY willingness-to-pay threshold. The base case result was robust to multiple one-way sensitivity analyses. The main drivers were response rate to the initial screening questionnaire and attendance rate for the confirmatory spirometry test.DiscussionRegular systematic case-finding for COPD using a screening questionnaire in primary care is likely to be cost-effective in the long-term despite uncertainties in treatment effectiveness. Further knowledge of the natural history of case-found patients and the effectiveness of their management will improve confidence to implement such an approach.

scholarly journals Prevalence and Natural History of Hepatitis C Infection in Patients Cured of Childhood Leukemia

Blood ◽  
1997 ◽  
Vol 90 (11) ◽  
pp. 4628-4633 ◽  
Author(s):  
Anna Locasciulli ◽  
Marina Testa ◽  
Patrizia Pontisso ◽  
Luisa Benvegnù ◽  
Donatella Fraschini ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Natural History ◽  
Childhood Leukemia ◽  
Liver Function Tests ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
History Of ◽  
Long Term Survivors

Abstract The aim of this study was to ascertain prevalence and natural history of hepatitis C virus (HCV) infection in a large cohort of patients cured of childhood leukemia who had been followed prospectively for liver disease for at least 10 years since chemotherapy withdrawal: 114 consecutive patients entered the study. Liver function tests and ultrasonography were used to assess presence of liver disease. Patients were tested for antibody to HCV and for serum HCV-RNA at the end of chemotherapy and at the end of follow-up. At chemotherapy withdrawal, 56 patients (49%) were HCV-RNA positive, often without detectable anti-HCV, and in these cases, transaminase levels were more elevated during (P = .08) and after (P = .04) chemotherapy compared with HCV-RNA negative cases. Patients were then followed-up 13 to 27 years (mean, 17) after chemotherapy withdrawal. During this period, 38 initially anti-HCV negative patients seroconverted to anti-HCV and 17 initially anti-HCV positive cases lost reactivity. Forty patients were persistently HCV-RNA positive in serum, while 16 initially viremic patients became HCV-RNA negative during follow-up. At the end of the observation period, a persistent transaminase elevation was detected only in four HCV-RNA positive and anti-HCV positive cases, while no patient developed signs or symptoms of decompensated liver disease. Thus, hepatitis C was a frequent finding in long-term survivors after chemotherapy. It was associated with an atypical serologic profile and did not cause severe liver impairment over a period of 13 to 27 years.

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