Study
February 21, 2012
February 21, 2012 vol. 156 no. 4 279-290
Shan Liu, SM; Lauren E. Cipriano, BSc, BA; Mark Holodniy, MD; Douglas K. Owens, MD, MS; and Jeremy D. Goldhaber-Fiebert, PhDAbstract
Background: Chronic hepatitis C virus is difficult to treat and affects approximately 3 million Americans. Protease inhibitors increase the effectiveness of standard therapy, but they are costly. A genetic assay may identify patients most likely to benefit from this treatment advance.
Objective: To assess the cost-effectiveness of new protease inhibitors and an interleukin (IL)–28B genotyping assay for treating chronic hepatitis C virus.
Design: Decision-analytic Markov model.
Data Sources: Published literature and expert opinion.
Target Population: Treatment-naive patients with chronic, genotype 1 hepatitis C virus monoinfection.
Time Horizon: Lifetime.
Perspective: Societal.
Intervention: Strategies are defined by the use of IL-28B genotyping and type of treatment (standard therapy [pegylated interferon with ribavirin]; triple therapy [standard therapy and a protease inhibitor]). Interleukin-28B–guided triple therapy stratifies patients with CC genotypes to standard therapy and those with non-CC types to triple therapy.
Outcome Measures: Discounted costs (in 2010 U.S. dollars) and quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios.
Results of Base-Case Analysis: For patients with mild and advanced fibrosis, universal triple therapy reduced the lifetime risk for hepatocellular carcinoma by 38% and 28%, respectively, and increased quality-adjusted life expectancy by 3% and 8%, respectively, compared with standard therapy. Gains from IL-28B–guided triple therapy were smaller. If the protease inhibitor costs $1100 per week, universal triple therapy costs $102 600 per QALY (mild fibrosis) or $51 500 per QALY (advanced fibrosis) compared with IL-28B–guided triple therapy and $70 100 per QALY (mild fibrosis) and $36 300 per QALY (advanced fibrosis) compared with standard therapy.
Results of Sensitivity Analysis: Results were sensitive to the cost of protease inhibitors and treatment adherence rates.
Limitation: Data on the long-term comparative effectiveness of the new protease inhibitors are lacking.
Conclusion: Both universal triple therapy and IL-28B–guided triple therapy are cost-effective when the least-expensive protease inhibitor are used for patients with advanced fibrosis.
The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings
A recent study, funded bу thе Centers fοr Disease Hegemony аnԁ Prevention, demonstrates thе cost effectiveness οf program baby boomers fοr HCV (Ann. Intern. Med. 2011 Nov. 4 [epub уеt tο bе οf print]).
The Associated Press | Feb. 20, 2012
Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers especially should take heed — they are most at risk.
Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if their livers harbor this ticking time bomb. The reason: Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days.
The issue has taken new urgency since two drugs hit the market last summer that promise to cure many more people than ever was possible. And research published Monday says testing millions of the middle-aged to find those who need the pricey treatment would be worth the cost, saving thousands of lives.
"One of every 33 baby boomers are living with hepatitis C infection," says Dr. John Ward, hepatitis chief at the Centers for Disease Control and Prevention. "Most people will be surprised, because it's a silent epidemic."
Sharing a needle while injecting illegal drugs is the biggest risk factor for becoming infected with this blood-borne virus. But before 1992, when widespread testing of the blood supply began, hepatitis C was commonly spread through blood transfusions. Plus, a one-time experiment with drugs way back in high school or college could have been enough.
"Asking someone about a risk that happened 20 to 30 years ago is a lot to ask," says Ward. Hence the quest for a new strategy.
About 3.2 million Americans are estimated to have chronic hepatitis C, but at least half of them may not know it. The virus, which affects 170 million people worldwide, can gradually scar the liver and lead to cirrhosis or liver cancer. It is a leading cause of liver transplants.
A CDC study published Monday analyzed a decade of death records and found an increase in death rates from hepatitis C. In fact, in 2007 there were 15,000 deaths related to hepatitis C, higher than previous estimates — and surpassing the nearly 13,000 deaths caused by the better-known AIDS virus.
Perhaps more surprising, three-fourths of the hepatitis deaths occurred in the middle-aged, people 45 to 64, researchers reported in Annals of Internal Medicine.
"Mortality will continue to grow for the next 10 to 15 years at least unless we do something different" to find and treat the silent sufferers, Ward says.
CDC's current guidelines recommend testing people known to be at high risk, and until last summer there wasn't much enthusiasm even for that step: the reasons are the year-long, two-drug treatment promised to cure only 40 percent of people; treatment was so grueling that many patients refused to try it and treatment could cost up to $30,000.
Two new drugs — Vertex Pharmaceuticals' telaprevir and Merck & Co.'s boceprevir — are starting to change that pessimism. Research suggests adding one of them to standard therapy can boost cure rates as high as 75 percent. While still full of side effects, they can allow some people to finish treatment in just six months. They add to the price, however, another $1,000 to $4,000 a week. Drugs that promise to work even better have begun testing.
Those advances are fueling CDC deliberations of whether to change testing guidelines to recommend that anyone born between 1945 and 1965 get a one-time screening. A second CDC-funded study published Monday analyzed models of that option, and concluded it had the potential to save 82,000 lives.
A third study published Monday from Stanford University looked more closely at the price tag, and concluded the new triple-therapy would be cost-effective for people with advanced disease. It's still cheaper than a transplant costing well over $100,000. But not everyone with hepatitis C will go on to suffer serious liver damage. For those with mild disease, that analysis concluded some gene testing to predict who might really need the costlier triple therapy rather than the older drugs would be a good next step.
It's not clear how quickly the CDC will settle the boomer-screening question. But doctors at New York's Montefiore Medical Center have started raising the issue with boomers. And Montefiore internist Dr. Gary Rogg says a number of patients have sought testing after seeing hepatitis-awareness ads from the drugs' manufacturers.
"Now it's considered a curable disease, that makes all the difference," says Rogg, who was surprised at some longtime patients' test results. Even a nurse he knows learned she had it, and the only risk she could recall was a blood transfusion during surgery when she was 10 years old.
Source
Also In The News
Hepatitis C Now Kills More Americans Than HIV
Also In The News
Hepatitis C Now Kills More Americans Than HIV
Middle-aged most often affected, and many are unaware they have been infected, CDC says
By Steven Reinberg
HealthDay Reporter
MONDAY, Feb. 20 (HealthDay News) -- Deaths from hepatitis C have increased steadily in the United States in recent years, in part because many people don't know they have disease, a new government report says.
MONDAY, Feb. 20 (HealthDay News) -- Deaths from hepatitis C have increased steadily in the United States in recent years, in part because many people don't know they have disease, a new government report says.
More Americans now die of hepatitis C than from HIV, the AIDS-causing virus, according to 1999-2007 data reviewed by the U.S. Centers for Disease Control and Prevention (CDC). And most of those dying are middle-aged.
"These data underscore the urgent need to address the health threat posed by chronic hepatitis B and C in the United States," said investigator Dr. Scott Holmberg, chief of the Epidemiology and Surveillance Branch in CDC's Division of Viral Hepatitis.
About 3.2 million Americans are infected with hepatitis C, a major cause of liver cancer and cirrhosis, the CDC authors said. An estimated one-half to three-quarters of infected adults are unaware they have the disease, which progresses slowly.
Hepatitis C is spread through injection drug use, from blood transfusions received before routine blood-screening began in 1992, and through sexual contact. In some cases, it passes from mothers to infants.
"Chronic hepatitis is a leading and preventable cause of premature death in the United States," Holmberg said. "Over time, leaving viral hepatitis untreated can lead to costly care and treatments, and lifetime costs can total hundreds of thousands of dollars. However, early detection and intervention can be cost-effective and save lives."
The new study highlights the need to increase hepatitis awareness and the critical importance of testing, Holmberg said. Screening will increase diagnoses and treatment, thereby reducing hepatitis-related deaths, he said.
The report is published in the Feb. 21 issue of the Annals of Internal Medicine.
Using death records from 1999 to 2007, researchers collected data on some 22 million Americans, looking for those who died from hepatitis B, C and HIV.
The investigators found deaths from hepatitis C surpassed deaths from HIV (15,000 from hepatitis C versus 13,000 from HIV). They also found that deaths from hepatitis C and B are mostly among the middle-aged.
"Seventy-three percent of hepatitis C deaths were reported among those 45 to 64 years old," Holmberg said. "As the population living with hepatitis C in the United States -- 66 percent of whom were born between 1945 and 1964 -- has aged and entered a high-risk period of life for hepatitis C-related disease, deaths associated with hepatitis C have increased substantially."
Vaccines exist for hepatitis B, but not for hepatitis C. If current trends continue, by 2030 deaths from hepatitis C are expected to reach 35,000 a year, researchers say.
According to Dr. Eugene Schiff, director of the Center for Liver Diseases at the University of Miami Miller School of Medicine, "the study is important because it documents and authenticates what we knew." But, "what we need right now, particularly for hepatitis C, is routine screening," noted Schiff, who was not involved with the study.
Dramatic changes are under way in the treatment of hepatitis C, he pointed out. Current treatment involves a cocktail of drugs, including antivirals and interferon, which many people cannot tolerate.
In about two years, interferon-free treatment will be available, Schiff said. This means higher cure rates with fewer side effects, which will make treatment tolerable by most patients, he explained.
"What's going to happen is what happened with HIV -- test and treat," Schiff said. "Patients will be given an interferon-free regimen with cure rates approaching 100 percent," he predicted.
Another study in the same journal issue found that the most up-to-date treatment for hepatitis C can cost $60,000, but may be cost-effective, according to Stanford University health policy researchers.
In a study led by Jeremy Goldhaber-Fiebert, an assistant professor of medicine at the School of Medicine, investigators developed a computer model to assess the cost-effectiveness of a new treatment for hepatitis C. Their model showed that for people with advanced disease the cost was justified in terms of results.
The treatment involves use of two drugs called protease inhibitors -- boceprevir (brand name Victrelis) and telaprevir (brand name Incivek) -- in addition to interferon and an antiviral.
While the new treatment is expensive and may cause side effects, it could reduce patients' risks for cancer and liver transplants, thereby avoiding those costly events and possibly helping patients live longer, better lives, the researchers pointed out in a journal news release.
Yet another study in the journal recommends one-time screening of all those born between 1945 and 1965, instead of waiting until symptoms appear.
More information
For more information on hepatitis, visit the U.S. Centers for Disease Control and Prevention.
SOURCES: Scott Holmberg, M.D., M.P.H., chief, epidemiology and surveillance branch, division of viral hepatitis, U.S. Centers for Disease Control and Prevention; Eugene R. Schiff, M.D., Leonard Miller Professor of Medicine, director, Schiff Liver Institute/Center for Liver Diseases, University of Miami Miller School of Medicine; Feb. 21, 2012, Annals of Internal Medicine
Put more money allocated for it! We get a very low percentage compared to AIDS. It is curable. Maybe the govt, wants us to die?
ReplyDeleteYes it is curable! As always this battle starts with testing, and awareness. We now have the scientific evidence which indicates that hepatitis C is a curable disease and a winnable battle. Which brings me to 2010 when the CDC missed an opportunity to name HCV as a winning battle.
ReplyDeleteBack In 2010 the CDC's six winning battles were-
Smoking
AIDS
Nutrition
Obesity
Teen pregnancy
Auto injuries
The CDC should have included HCV,and HBV as one of those winning battles. Hepatitis C was a winning battle in 2010 and doesn't Hepatitis B have a vaccine? We needed that 2010 awareness from the CDC.
This is a serious disease, an analysis published in the July 2011 issue of Clinical Infectious Diseases, suggest that HCV doubles the normal risk of dying early from any cause, the authors from the study concluded that early HCV testing/treatment and medical care is essential.
In 2012 awareness is on the rise, and keeping HCV in headlines is what we all want more of.
I'm angry too-