Hepatitis C in the United States

Holmberg, Scott D.; Spradling, Philip R.; Moorman, Anne C.; Denniston, Maxine M.

doi:10.1056/nejmp1302973

Cited by 280 publications

(264 citation statements)

References 4 publications

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“…Based on two large U.S. cohorts (Chronic Hepatitis Cohort Study: CHeCS and the National Health and Nutrition Examination Survey: NHANES) analyzed by the Division of Viral Hepatitis at the Centers for Disease Control and Prevention (CDC), only 13-18% of individuals chronically infected with HCV receive treatment. 6 Other studies support this abysmal treatment uptake. In another recent interrogation of a large healthcare payer database, only 10.9% of 57,084 HCV-infected patients have received HCV therapy.…”

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confidence: 85%

Sticker shock and the price of new therapies for hepatitis C: Is it worth it?

Reau

Jensen

2014

Hepatology

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confidence: 85%

Sticker shock and the price of new therapies for hepatitis C: Is it worth it?

Reau

Jensen

2014

Hepatology

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“…[1][2][3][4] The Centers for Disease Control and Prevention (CDC) has recommended that individuals born between 1945 and 1965 be uniformly educated, screened, and properly linked to HCV care and treatment, given that this cohort accounts for 75 % of infections. [5][6][7][8][9] The economic burden from HCV-related morbidity and mortality in the near term will largely be attributed to this cohort as the HCV-positive population ages and develops cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

“…1,5,10,11 While recommendations for uniform screening based on the age cohort are becoming more widely embraced, targeted screening within key high-risk groups remains important. 1,4 Incarcerated individuals are at high risk for HCV due to higher rates of transmission risk behaviors among those incarcerated, such as injection drug use. [10][11][12][13][14][15][16][17][18][19][20] A 2013 meta-analysis estimated the HCV prevalence in general detainees to be 26 % worldwide and 29 % in North America.…”

Section: Introductionmentioning

confidence: 99%

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

et al. 2015

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Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCVin corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17 % of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50 % reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

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“…A long-term follow-up study of NAFLD patients showed that patients with NASH have lower survival rates compared to patients with simple steatosis, and most of the patients in the follow-up period developed type 2 diabetes or impaired glucose tolerance [2]. Cirrhosis as a result of NAFLD is predicted to surpass chronic hepatitis C (CHC) as the leading indication for liver transplantation in the USA within the next 5 years, as the incidence of CHC is decreasing whereas that of NAFLD is increasing [4].Although cirrhosis is a major risk factor for hepatocellular carcinoma (HCC) development, a growing number of case reports and small patient series demonstrate that liver cancers sometimes develop in individuals with NAFLD who do not also have cirrhosis [5]. The studies published in Hepatology International have provided further insight into the natural history of NAFLD and HCC.…”

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confidence: 99%

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confidence: 99%

NAFLD as a risk factor for HCC: new rules of engagement?

2016

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Non-alcoholic fatty liver disease (NAFLD) is increasingly diagnosed worldwide and is the most common cause of abnormal liver function tests and chronic liver disease in clinical practice. Although most patients with simple steatosis will have stable disease, 10-15 % with histologically proven non-alcoholic steatohepatitis (NASH) will progress to cirrhosis and its complications such as liver failure and hepatocellular carcinoma [1][2][3]. A long-term follow-up study of NAFLD patients showed that patients with NASH have lower survival rates compared to patients with simple steatosis, and most of the patients in the follow-up period developed type 2 diabetes or impaired glucose tolerance [2]. Cirrhosis as a result of NAFLD is predicted to surpass chronic hepatitis C (CHC) as the leading indication for liver transplantation in the USA within the next 5 years, as the incidence of CHC is decreasing whereas that of NAFLD is increasing [4].Although cirrhosis is a major risk factor for hepatocellular carcinoma (HCC) development, a growing number of case reports and small patient series demonstrate that liver cancers sometimes develop in individuals with NAFLD who do not also have cirrhosis [5]. The studies published in Hepatology International have provided further insight into the natural history of NAFLD and HCC. In this issue, Mohamad and colleagues [6] carefully investigated the characterization of NAFLD-related HCC patients with or without cirrhosis. Thirty-six patients with NAFLD and HCC in NCL (HCC-NCL group) were identified and compared to 47 patients with NAFLD-HCC and liver cirrhosis (HCC-LC group). Liver fibrosis was not present in 55.9 % of patients in the HCC-NCL group (F0), stage 1 was present in 17.6 %, stage 2 in 8.8 % and stage 3 in 17.6 %. Lobular inflammation was present in 63.6 % of non-cirrhotic patients. Patients in the HCC-NCL were older (67.5 ± 12.3 vs. 62.7 ± 8.1 years), and less likely to be obese (52 vs. 83 %) or have type 2 diabetes (38 vs. 83 %), with p values \0.05 for all. More interestingly, compared with the HCC-CL group, those in the HCC-NCL group were more likely to present with a single nodule (80.6 vs. 52.2 %), larger nodule size ([5 cm) (77.8 vs. 10.6 %), and receive hepatic resection as the modality of HCC treatment (66.7 vs. 17 %), and were less likely to receive loco-regional therapy (22.3 vs. 61.7 %) or orthotopic liver transplantation (OLT) (0 vs. 72.3 %), with p values \0.001 for all. These patients presented with larger tumors possibly because they did not receive regular medical check-ups due to their relatively preserved liver function. We have previously reported similar tumor characteristics in elderly HCC patients who also tended to have tumor markers with high DCP and low AFP [7,8]. These results suggested that there might be a relationship between aging and HCC. Studying differences in tumor markers might be helpful in further understanding the tumor biology.The authors also analyzed the prognosis of patients and found 86 % of patients without cirrhosis had HCC recurren...

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Hepatitis C in the United States

Cited by 280 publications

References 4 publications

Sticker shock and the price of new therapies for hepatitis C: Is it worth it?

Sticker shock and the price of new therapies for hepatitis C: Is it worth it?

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

NAFLD as a risk factor for HCC: new rules of engagement?

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