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Anyway, our friends at Clinical Care Options (CCO) have released slides from their recent satellite symposium in San Francisco, with expert commentary on the use of direct-acting antiviral HCV therapy in liver transplantation patients.
Click here to begin.
Redefining Best Practices in HCV Management in the Transplant Setting
In this downloadable slideset, Norah Terrault, MD, MPH, leads a review of a series of cases with Jean C. Emond, MD, and Paul Y. Kwo, MD, evaluating the optimal use of available HCV therapies in the pretransplantation and posttransplantation patients.
Key Challenges in HCV Management in the Transplant Setting
In this downloadable slideset, Jean C. Edmond, MD, offers insight into managing HCV in pretransplant and posttransplant patients.
Interferon-Free HCV Therapy in the Transplant Setting
In this downloadable slideset, Paul Y. Kwo, MD, reviews current and forthcoming options for interferon-free treatment of pretransplantation and posttransplantation patients with HCV.
Prioritizing Patients for HCV Therapy: The Case for Treating Before Advanced Disease
In addition, Nancy Reau, MD., offers commentary on the cost of treating HCV, why patients may wait to start therapy, and liver-related effects (extrahepatic manifestations) seen in certain individuals living with this sometimes life threatening disease. See the article provided below.
A quick free registration is required to view links provided in the article, and to download slides.
Of Interest:
Over at NATAP, Mr. Jules Levin has provided slides from the AASLD/EASL Special Conference, which took place in NY this month. On the topic of extrahepatic manifestations in relation to HCV therapy, I thought this was of interest;
Most patients with HCV-associated lymphoma present with mild liver disease at cancer diagnosis: A call to revise indications for HCV treatment
Chronic hepatitis C virus (HCV) infection is clearly associated with significant liver-related morbidity and mortality, but HCV infection can also cause life-threatening effects outside of the liver, such as vasculitis, renal failure, and malignancies. Those infected with HCV have higher all-cause mortality rates, including higher mortality from cerebrovascular and kidney diseases. The risk for insulin resistance is also increased, and in those with established diabetes, HCV infection increases the risk of cardiovascular and renal events.
Fortunately, HCV is curable, and cure decreases the risk for liver-related mortality, liver cancer, and insulin resistance and lowers all-cause mortality. So why would any patient choose not to receive therapy?
Past Reasons for Treatment Deferral
Traditionally, HCV treatment has involved undesired adverse effects that, at the least, can affect quality of life—for some, significantly so. Many individuals have deferred therapy, choosing to live with a disease that can be deadly but is often asymptomatic or minimally symptomatic for many years.
However, current HCV therapy includes well-tolerated, highly efficacious, all-oral options. Treatment duration is rarely longer than 12 weeks and expected cure rates exceed 90% for most patients. Given these vast improvements in treatment options, why do we continue to see delays in therapy initiation?
The Impact of Access on Treatment Rates
The answer is access. Namely, access to insurance coverage of these new drugs is a limiting step in initiating treatment for many patients. Current all-oral options cost in excess of $100,000 in the United States. In my practice, it is not rare for individuals seeking approval from their insurance companies to be denied coverage, unless they have well-established advanced disease. It is undeniable that those with advanced disease urgently need treatment. However, eradicating disease when fibrosis is already advanced is not preventive care, as cure at this stage does not eliminate all risk of future complications. Despite successful therapy, patients with cirrhosis will require long-term monitoring for liver cancer and manifestations of decompensated cirrhosis. This subset of patients is still the most likely to use future healthcare resources, especially those who are unlucky enough to develop hepatocellular carcinoma despite cure of their HCV. The cost of liver transplantation is estimated at $500,000 without considering the associated costs of subsequent lifelong immune suppression. Local-regional cancer management is expensive, and studies have confirmed that those with cirrhosis, especially decompensated cirrhosis, require more hospitalizations.
Costs Associated With Treatment Deferral
Deferral of therapy may increase risk to those not considered to be a priority. For instance, HCV treatment could prevent the onset of diabetes, improve glycemic control, and prevent diabetes-associated complications. Similar to cardiovascular prevention, HCV eradication should be an important aspect to risk reduction. In addition, once extrahepatic manifestations of HCV occur, such as vasculitis, they do not always improve with elimination of the virus.
Studies also suggest that healthcare utilization may not be solely linked to disease stage and that patients in earlier stages of disease still use resources in terms of disease management and monitoring. Deferral of therapy may also mean deferral of costs. Notably, between 2001-2010, inpatient care for those infected with HCV cost $15 billion; 71% of admissions involved patients born in the CDC-identified birth cohort (individuals born between 1945-1965).
The Impact of Reduced Access on Patients
Limited access to therapy is frustrating for patients, who face being told that there is a curative therapy but access to treatment cannot be gained until severe consequences develop that are preventable but possibly not reversible. Ideal timing of therapy is nebulous but certainly occurs before significant fibrosis or debilitating extrahepatic manifestations emerge.
Your Thoughts?
I want to hear from you on this issue. How do you believe access to HCV therapy should be managed, and how are you managing it in your practice? I encourage readers throughout the world to share your insights and challenges in the comments section below.
Topics: HCV - Treatment
If you haven't read this article; New Hepatitis C Drugs and Faulty Journalism, by Lucinda K. Porter, RN., I hope you consider taking the time to review it.
See you all soon.
Prioritizing Patients for HCV Therapy: The Case for Treating Before Advanced Disease
Chronic hepatitis C virus (HCV) infection is clearly associated with significant liver-related morbidity and mortality, but HCV infection can also cause life-threatening effects outside of the liver, such as vasculitis, renal failure, and malignancies. Those infected with HCV have higher all-cause mortality rates, including higher mortality from cerebrovascular and kidney diseases. The risk for insulin resistance is also increased, and in those with established diabetes, HCV infection increases the risk of cardiovascular and renal events.
Fortunately, HCV is curable, and cure decreases the risk for liver-related mortality, liver cancer, and insulin resistance and lowers all-cause mortality. So why would any patient choose not to receive therapy?
Past Reasons for Treatment Deferral
Traditionally, HCV treatment has involved undesired adverse effects that, at the least, can affect quality of life—for some, significantly so. Many individuals have deferred therapy, choosing to live with a disease that can be deadly but is often asymptomatic or minimally symptomatic for many years.
However, current HCV therapy includes well-tolerated, highly efficacious, all-oral options. Treatment duration is rarely longer than 12 weeks and expected cure rates exceed 90% for most patients. Given these vast improvements in treatment options, why do we continue to see delays in therapy initiation?
The Impact of Access on Treatment Rates
The answer is access. Namely, access to insurance coverage of these new drugs is a limiting step in initiating treatment for many patients. Current all-oral options cost in excess of $100,000 in the United States. In my practice, it is not rare for individuals seeking approval from their insurance companies to be denied coverage, unless they have well-established advanced disease. It is undeniable that those with advanced disease urgently need treatment. However, eradicating disease when fibrosis is already advanced is not preventive care, as cure at this stage does not eliminate all risk of future complications. Despite successful therapy, patients with cirrhosis will require long-term monitoring for liver cancer and manifestations of decompensated cirrhosis. This subset of patients is still the most likely to use future healthcare resources, especially those who are unlucky enough to develop hepatocellular carcinoma despite cure of their HCV. The cost of liver transplantation is estimated at $500,000 without considering the associated costs of subsequent lifelong immune suppression. Local-regional cancer management is expensive, and studies have confirmed that those with cirrhosis, especially decompensated cirrhosis, require more hospitalizations.
Costs Associated With Treatment Deferral
Deferral of therapy may increase risk to those not considered to be a priority. For instance, HCV treatment could prevent the onset of diabetes, improve glycemic control, and prevent diabetes-associated complications. Similar to cardiovascular prevention, HCV eradication should be an important aspect to risk reduction. In addition, once extrahepatic manifestations of HCV occur, such as vasculitis, they do not always improve with elimination of the virus.
Studies also suggest that healthcare utilization may not be solely linked to disease stage and that patients in earlier stages of disease still use resources in terms of disease management and monitoring. Deferral of therapy may also mean deferral of costs. Notably, between 2001-2010, inpatient care for those infected with HCV cost $15 billion; 71% of admissions involved patients born in the CDC-identified birth cohort (individuals born between 1945-1965).
The Impact of Reduced Access on Patients
Limited access to therapy is frustrating for patients, who face being told that there is a curative therapy but access to treatment cannot be gained until severe consequences develop that are preventable but possibly not reversible. Ideal timing of therapy is nebulous but certainly occurs before significant fibrosis or debilitating extrahepatic manifestations emerge.
Your Thoughts?
I want to hear from you on this issue. How do you believe access to HCV therapy should be managed, and how are you managing it in your practice? I encourage readers throughout the world to share your insights and challenges in the comments section below.
Topics: HCV - Treatment
If you haven't read this article; New Hepatitis C Drugs and Faulty Journalism, by Lucinda K. Porter, RN., I hope you consider taking the time to review it.
See you all soon.
Tina
I believe we should be treated when the doctor says so not when some INSURANCE company does!!!!!That seems to be the problem..
ReplyDelete