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American Association for the Study of Liver Disease (AASLD): The Liver Meeting
HCV Regimen Worked After Sofosbuvir Combos Failed
BOSTON – All but 1 of 51 patients who failed sofosbuvir-containing treatment regimens for hepatitis C achieved a sustained virologic response for 12 weeks after retreatment with ledipasvir and sofosbuvir plus ribavirin.
The study was supposed to include only patients with genotype 1 hepatitis C virus (HCV), but the one patient who failed retreatment turned out to have genotype 3a and had been enrolled in error, Dr. David L. Wyles said at the annual meeting of the American Association for the Study of Liver Diseases.
Among the 50 patients with genotype 1, retreatment achieved a sustained virologic response for 12 weeks (SVR12) in 100%, reported Dr. Wyles of the University of California, San Diego, and his associates.
The patients had failed to achieve SVR12 after prior treatment in clinical trials using sofosbuvir plus pegylated interferon and ribavirin (25 patients), sofosbuvir with or without ribavirin (21 patients), or sofosbuvir and placebo (5 patients).
The cohort had a mean age of 54 years, 31 patients were male (61%), 8 were African American (16%), and the mean body mass index was 30 kg/m2. Fifteen patients had cirrhosis (29%).
Genetic resistance analyses conducted before retreatment showed that no patients had the sofosbuvir-associated variant S282T, but two patients had the NS5B treatment-emergent variant L159F, and each of them achieved SVR12 after retreatment.
Adverse events were reported by 41 patients (80%) and serious adverse events by 2 patients (4%), including bipolar disorder, chest pain, anemia, and cholecystitis. The most common adverse events included fatigue in 13 patients (25%), headache in 11 (22%), diarrhea in 7 (14%), rash in 6 (12%), and insomnia or nausea in 5 patients each (10% each). Most adverse events were mild or moderate in severity.
Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
BOSTON – All but 1 of 51 patients who failed sofosbuvir-containing treatment regimens for hepatitis C achieved a sustained virologic response for 12 weeks after retreatment with ledipasvir and sofosbuvir plus ribavirin.
The study was supposed to include only patients with genotype 1 hepatitis C virus (HCV), but the one patient who failed retreatment turned out to have genotype 3a and had been enrolled in error, Dr. David L. Wyles said at the annual meeting of the American Association for the Study of Liver Diseases.
Among the 50 patients with genotype 1, retreatment achieved a sustained virologic response for 12 weeks (SVR12) in 100%, reported Dr. Wyles of the University of California, San Diego, and his associates.
The patients had failed to achieve SVR12 after prior treatment in clinical trials using sofosbuvir plus pegylated interferon and ribavirin (25 patients), sofosbuvir with or without ribavirin (21 patients), or sofosbuvir and placebo (5 patients).
The cohort had a mean age of 54 years, 31 patients were male (61%), 8 were African American (16%), and the mean body mass index was 30 kg/m2. Fifteen patients had cirrhosis (29%).
Genetic resistance analyses conducted before retreatment showed that no patients had the sofosbuvir-associated variant S282T, but two patients had the NS5B treatment-emergent variant L159F, and each of them achieved SVR12 after retreatment.
Adverse events were reported by 41 patients (80%) and serious adverse events by 2 patients (4%), including bipolar disorder, chest pain, anemia, and cholecystitis. The most common adverse events included fatigue in 13 patients (25%), headache in 11 (22%), diarrhea in 7 (14%), rash in 6 (12%), and insomnia or nausea in 5 patients each (10% each). Most adverse events were mild or moderate in severity.
Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
BOSTON – All but 1 of 51 patients who failed sofosbuvir-containing treatment regimens for hepatitis C achieved a sustained virologic response for 12 weeks after retreatment with ledipasvir and sofosbuvir plus ribavirin.
The study was supposed to include only patients with genotype 1 hepatitis C virus (HCV), but the one patient who failed retreatment turned out to have genotype 3a and had been enrolled in error, Dr. David L. Wyles said at the annual meeting of the American Association for the Study of Liver Diseases.
Among the 50 patients with genotype 1, retreatment achieved a sustained virologic response for 12 weeks (SVR12) in 100%, reported Dr. Wyles of the University of California, San Diego, and his associates.
The patients had failed to achieve SVR12 after prior treatment in clinical trials using sofosbuvir plus pegylated interferon and ribavirin (25 patients), sofosbuvir with or without ribavirin (21 patients), or sofosbuvir and placebo (5 patients).
The cohort had a mean age of 54 years, 31 patients were male (61%), 8 were African American (16%), and the mean body mass index was 30 kg/m2. Fifteen patients had cirrhosis (29%).
Genetic resistance analyses conducted before retreatment showed that no patients had the sofosbuvir-associated variant S282T, but two patients had the NS5B treatment-emergent variant L159F, and each of them achieved SVR12 after retreatment.
Adverse events were reported by 41 patients (80%) and serious adverse events by 2 patients (4%), including bipolar disorder, chest pain, anemia, and cholecystitis. The most common adverse events included fatigue in 13 patients (25%), headache in 11 (22%), diarrhea in 7 (14%), rash in 6 (12%), and insomnia or nausea in 5 patients each (10% each). Most adverse events were mild or moderate in severity.
Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
AT THE LIVER MEETING 2014
HCV regimen worked after sofosbuvir combos failed
BOSTON – All but 1 of 51 patients who failed sofosbuvir-containing treatment regimens for hepatitis C achieved a sustained virologic response for 12 weeks after retreatment with ledipasvir and sofosbuvir plus ribavirin.
The study was supposed to include only patients with genotype 1 hepatitis C virus (HCV), but the one patient who failed retreatment turned out to have genotype 3a and had been enrolled in error, Dr. David L. Wyles said at the annual meeting of the American Association for the Study of Liver Diseases.
Among the 50 patients with genotype 1, retreatment achieved a sustained virologic response for 12 weeks (SVR12) in 100%, reported Dr. Wyles of the University of California, San Diego, and his associates.
The patients had failed to achieve SVR12 after prior treatment in clinical trials using sofosbuvir plus pegylated interferon and ribavirin (25 patients), sofosbuvir with or without ribavirin (21 patients), or sofosbuvir and placebo (5 patients).
The cohort had a mean age of 54 years, 31 patients were male (61%), 8 were African American (16%), and the mean body mass index was 30 kg/m2. Fifteen patients had cirrhosis (29%).
Genetic resistance analyses conducted before retreatment showed that no patients had the sofosbuvir-associated variant S282T, but two patients had the NS5B treatment-emergent variant L159F, and each of them achieved SVR12 after retreatment.
Adverse events were reported by 41 patients (80%) and serious adverse events by 2 patients (4%), including bipolar disorder, chest pain, anemia, and cholecystitis. The most common adverse events included fatigue in 13 patients (25%), headache in 11 (22%), diarrhea in 7 (14%), rash in 6 (12%), and insomnia or nausea in 5 patients each (10% each). Most adverse events were mild or moderate in severity.
Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – All but 1 of 51 patients who failed sofosbuvir-containing treatment regimens for hepatitis C achieved a sustained virologic response for 12 weeks after retreatment with ledipasvir and sofosbuvir plus ribavirin.
The study was supposed to include only patients with genotype 1 hepatitis C virus (HCV), but the one patient who failed retreatment turned out to have genotype 3a and had been enrolled in error, Dr. David L. Wyles said at the annual meeting of the American Association for the Study of Liver Diseases.
Among the 50 patients with genotype 1, retreatment achieved a sustained virologic response for 12 weeks (SVR12) in 100%, reported Dr. Wyles of the University of California, San Diego, and his associates.
The patients had failed to achieve SVR12 after prior treatment in clinical trials using sofosbuvir plus pegylated interferon and ribavirin (25 patients), sofosbuvir with or without ribavirin (21 patients), or sofosbuvir and placebo (5 patients).
The cohort had a mean age of 54 years, 31 patients were male (61%), 8 were African American (16%), and the mean body mass index was 30 kg/m2. Fifteen patients had cirrhosis (29%).
Genetic resistance analyses conducted before retreatment showed that no patients had the sofosbuvir-associated variant S282T, but two patients had the NS5B treatment-emergent variant L159F, and each of them achieved SVR12 after retreatment.
Adverse events were reported by 41 patients (80%) and serious adverse events by 2 patients (4%), including bipolar disorder, chest pain, anemia, and cholecystitis. The most common adverse events included fatigue in 13 patients (25%), headache in 11 (22%), diarrhea in 7 (14%), rash in 6 (12%), and insomnia or nausea in 5 patients each (10% each). Most adverse events were mild or moderate in severity.
Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – All but 1 of 51 patients who failed sofosbuvir-containing treatment regimens for hepatitis C achieved a sustained virologic response for 12 weeks after retreatment with ledipasvir and sofosbuvir plus ribavirin.
The study was supposed to include only patients with genotype 1 hepatitis C virus (HCV), but the one patient who failed retreatment turned out to have genotype 3a and had been enrolled in error, Dr. David L. Wyles said at the annual meeting of the American Association for the Study of Liver Diseases.
Among the 50 patients with genotype 1, retreatment achieved a sustained virologic response for 12 weeks (SVR12) in 100%, reported Dr. Wyles of the University of California, San Diego, and his associates.
The patients had failed to achieve SVR12 after prior treatment in clinical trials using sofosbuvir plus pegylated interferon and ribavirin (25 patients), sofosbuvir with or without ribavirin (21 patients), or sofosbuvir and placebo (5 patients).
The cohort had a mean age of 54 years, 31 patients were male (61%), 8 were African American (16%), and the mean body mass index was 30 kg/m2. Fifteen patients had cirrhosis (29%).
Genetic resistance analyses conducted before retreatment showed that no patients had the sofosbuvir-associated variant S282T, but two patients had the NS5B treatment-emergent variant L159F, and each of them achieved SVR12 after retreatment.
Adverse events were reported by 41 patients (80%) and serious adverse events by 2 patients (4%), including bipolar disorder, chest pain, anemia, and cholecystitis. The most common adverse events included fatigue in 13 patients (25%), headache in 11 (22%), diarrhea in 7 (14%), rash in 6 (12%), and insomnia or nausea in 5 patients each (10% each). Most adverse events were mild or moderate in severity.
Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
On Twitter @sherryboschert
AT THE LIVER MEETING 2014
Key clinical point: Retreatment with ledipasvir and sofosbuvir achieved a sustained virologic response for 12 weeks after therapy in patients with hepatitis C who failed other sofosbuvir regimens.
Major finding: All 50 patients with genotype 1 HCV achieved SVR12, and 1 patient with genotype 3a did not.
Data source: Analysis of data on patients who failed prior treatment with sofosbuvir plus pegylated interferon and ribavirin, sofosbuvir with or without ribavirin, or sofosbuvir and placebo in clinical trials.
Disclosures: Gilead funded the study. Dr. Wyles is a consultant for Gilead, AbbVie, and Bristol-Myers Squibb.
Best HCV value? Screen all baby boomers, treat all infections
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
AT THE LIVER MEETING 2014
Key clinical point: Screening adults born in 1945-1965 and treating all who have HCV with oral anti-HCV regimens is most cost effective.
Major finding: The strategy’s incremental cost of $36,585 is below the $50,000 per QALY threshold for cost effectiveness.
Data source: A computer simulation analysis that compared four strategies for screening and treatment, with treatment costs based on an estimated $1,000/day for sofosbuvir.
Disclosures: Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead, which markets sofosbuvir, and Bristol-Myers Squibb.
Best HCV value? Screen all baby boomers, treat all infections
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
AT THE LIVER MEETING 2014
Key clinical point: Screening adults born in 1945-1965 and treating all who have HCV with oral anti-HCV regimens is most cost effective.
Major finding: The strategy’s incremental cost of $36,585 is below the $50,000 per QALY threshold for cost effectiveness.
Data source: A computer simulation analysis that compared four strategies for screening and treatment, with treatment costs based on an estimated $1,000/day for sofosbuvir.
Disclosures: Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead, which markets sofosbuvir, and Bristol-Myers Squibb.
Best HCV Value? Screen All Baby Boomers, Treat All Infections
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
AT THE LIVER MEETING 2014
Best HCV value? Screen all baby boomers, treat all infections
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
BOSTON – Screening all adults born between 1945 and 1965 for hepatitis C and then treating all infected patients with oral drug regimens is the most cost effective strategy for society, because better outcomes more than offset the higher costs of wider screening and newer drugs, Dr. Zobair Younossi said.
A computer simulation analysis that compared four strategies for screening and treatment (plus the option of no screening or treatment) found that birth cohort screening and treatment of all hepatitis C virus–positive patients would save more than 4 million life-years at an incremental cost of $36,585 per quality-adjusted life-year (QALY), he reported at the annual meeting of the American Association for the Study of Liver Diseases.
That strategy produced an incremental cost-effectiveness ratio well below the widely accepted threshold of $50,000 per QALY used to define cost effectiveness in health care, said Dr. Younossi, professor of medicine at Virginia Commonwealth University’s Inova Campus and chair of Liver Disease Services for Inova, Falls Church, Va.
In first-generation treatment with direct-acting antivirals – namely, triple therapy with protease inhibitors – the mean cost to achieve a sustained virologic response was $172,889, he said, “and we did not get a lot of pushback from the payers at that point.”
Risk-based screening for HCV has been recommended, and the Centers for Disease Control and Prevention recently recommended birth cohort screening of people born between 1945 and 1965, the so-called baby boomers, Dr. Younossi said.
Still, studies suggest that less than 10% of patients with chronic HCV have been treated successfully, because of the failure of risk-based screening to identify all infected patients and the low efficacy and high rate of side effects from regimens based on interferon and ribavirin, he said.
Higher costs, lower risks
Dr. Younossi’s study used computer simulations to analyze the economic impact of various screening strategies followed by treatment with oral anti-HCV regimens.
The four strategies involved either risk-based screening or birth cohort screening, followed by treatment that either gave all HCV-infected patients oral regimens or that based treatment on staging, giving oral medications only to patients with significant fibrosis. The investigators also considered a fifth strategy: no screening and no treatment.
Birth cohort screening would lead to 1,162,323 patients being diagnosed with previously unknown chronic HCV, they estimated.
To estimate treatment costs, the investigators began with risk-based screening probabilities from a previous study: They assumed that 98% of patients would be medically eligible for treatment and have no contraindications to all-oral treatment regimens, and 98% of those treated would achieve a sustained virologic response for 12 weeks (SVR12), based on results of published trials.
The cost of oral direct-acting antiviral therapy was based on the cost of sofosbuvir – around $1,000 per day for 12 weeks, Dr. Younossi said. Costs for testing, staging, monitoring, and other data were taken from previous treatment models. The investigators calculated QALY from patients’ health utility reports in clinical trials.
Costs averaged approximately $88,000 per patient with birth cohort screening and treating all positive patients, $72,000 per patient with birth cohort screening and treatment based on staging, $60,000-$61,000 per patient for the risk-based screening strategies, and $53,000 per patient with no screening and no treatment.
The probabilities of cirrhosis, hepatocellular carcinoma, or liver transplant were much lower with either birth cohort screening strategy, however, compared with the risk-based strategies or no screening. The probability of cirrhosis was approximately 1% with birth cohort screening and treating all positive patients, 7% with birth cohort screening and treatment based on staging, 55%-60% with the risk-based strategies, and 67% with no screening.
The risk of hepatocellular carcinoma was 4% with birth cohort screening and treating all positive patients, 5% with birth cohort screening and treatment based on staging, 15% with either risk-based screening strategy, and 20% with no screening. The risk of liver transplant was 0.6% with either birth cohort screening strategy, 3% with either risk-based screening strategy, and nearly 4% with no screening.
A total of 4% of patients would be expected to die of liver-related causes after birth cohort screening and treating all positive patients, compared with 7% liver-related mortality after birth cohort screening and staging-based treatment, 25% liver-related mortality in either of the risk-based screening groups, and 34% liver-related mortality with no screening.
HCV costlier than other conditions?
When considering governmental health policy and budgetary issues, Dr. Younossi explained, the cost of curing HCV is not very different from lifetime treatment costs for type 2 diabetes, rheumatoid arthritis, or breast cancer with metastases – and it’s significantly lower than lifetime treatment costs for HIV or relapsing-remitting multiple sclerosis.
As advocates for patients, physicians need to lobby officials so that “as they are dividing the pie, hepatology and HCV are represented,” he said. “These regimens are cost effective.”
The study was an underestimation of savings from birth cohort screening and treating all HCV positives, Dr. Younossi noted, because it did not incorporate an estimated $3 billion per year in savings from work productivity in the United States by curing HCV.
A physician in the audience countered Dr. Younossi’s call for more enlightened health policy supporting funding for HCV treatment, noting that drug companies also need to be pressured to lower the price of the newer drugs.
“The biggest bridge we have to cross is the cost of the drugs,” he said. “This is like denying somebody treatment for tuberculosis by making the cost of the drug too high.”
“I agree,” Dr. Younossi said. “We have to focus on our colleagues in the industry. But we also have to focus on our colleagues in Congress and the policymakers to make sure that, even if we get help from the industry side, we also get help from the policymakers to provide us” with the funding for access to HCV screening and treatment.
Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead and Bristol-Myers Squibb.
On Twitter @sherryboschert
AT THE LIVER MEETING 2014
Key clinical point: Screening adults born in 1945-1965 and treating all who have HCV with oral anti-HCV regimens is most cost effective.
Major finding: The strategy’s incremental cost of $36,585 is below the $50,000 per QALY threshold for cost effectiveness.
Data source: A computer simulation analysis that compared four strategies for screening and treatment, with treatment costs based on an estimated $1,000/day for sofosbuvir.
Disclosures: Dr. Younossi reported having no financial disclosures. One of his coinvestigators reported financial associations with Gilead, which markets sofosbuvir, and Bristol-Myers Squibb.
VIDEO: Pediatric NAFLD Worsens As Kids Age
BOSTON – Pediatric nonalcoholic fatty liver disease progresses as children age to a more adult pattern of disease, a paired-biopsy study shows.
“As they grow older, they are facing liver transplant and potentially hepatocellular carcinoma, just as the adults do,” Dr. Elizabeth M. Brunt said during an interview at the annual meeting of the American Association for the Study of Liver Diseases.
Among 102 children studied, the zone 1 (borderline 1b) diagnostic pattern decreased from 27.5% to 9.8%, while the more “adult” NAFLD zone 3 (borderline 1a) pattern and definite steatohepatitis patterns both increased from 14.7% and 28.4% to 18.6% and 29.4%.
Moreover, cirrhosis was seen in nearly 3% of children at first biopsy, but by the second biopsy, nearly 20% of children had advanced fibrosis or cirrhosis, she said.
The findings are troubling because the United States is in the midst of an obesity epidemic, and obesity is associated with high rates of fatty liver disease, said Dr. Brunt of Washington University, St. Louis.
The National Institutes of Health supported the study. Dr. Brunt reported consulting for Synageva, serving as an independent contractor for Rottapharm and Kadmon, and speaking and teaching for the Geneva Foundation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Pediatric nonalcoholic fatty liver disease progresses as children age to a more adult pattern of disease, a paired-biopsy study shows.
“As they grow older, they are facing liver transplant and potentially hepatocellular carcinoma, just as the adults do,” Dr. Elizabeth M. Brunt said during an interview at the annual meeting of the American Association for the Study of Liver Diseases.
Among 102 children studied, the zone 1 (borderline 1b) diagnostic pattern decreased from 27.5% to 9.8%, while the more “adult” NAFLD zone 3 (borderline 1a) pattern and definite steatohepatitis patterns both increased from 14.7% and 28.4% to 18.6% and 29.4%.
Moreover, cirrhosis was seen in nearly 3% of children at first biopsy, but by the second biopsy, nearly 20% of children had advanced fibrosis or cirrhosis, she said.
The findings are troubling because the United States is in the midst of an obesity epidemic, and obesity is associated with high rates of fatty liver disease, said Dr. Brunt of Washington University, St. Louis.
The National Institutes of Health supported the study. Dr. Brunt reported consulting for Synageva, serving as an independent contractor for Rottapharm and Kadmon, and speaking and teaching for the Geneva Foundation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Pediatric nonalcoholic fatty liver disease progresses as children age to a more adult pattern of disease, a paired-biopsy study shows.
“As they grow older, they are facing liver transplant and potentially hepatocellular carcinoma, just as the adults do,” Dr. Elizabeth M. Brunt said during an interview at the annual meeting of the American Association for the Study of Liver Diseases.
Among 102 children studied, the zone 1 (borderline 1b) diagnostic pattern decreased from 27.5% to 9.8%, while the more “adult” NAFLD zone 3 (borderline 1a) pattern and definite steatohepatitis patterns both increased from 14.7% and 28.4% to 18.6% and 29.4%.
Moreover, cirrhosis was seen in nearly 3% of children at first biopsy, but by the second biopsy, nearly 20% of children had advanced fibrosis or cirrhosis, she said.
The findings are troubling because the United States is in the midst of an obesity epidemic, and obesity is associated with high rates of fatty liver disease, said Dr. Brunt of Washington University, St. Louis.
The National Institutes of Health supported the study. Dr. Brunt reported consulting for Synageva, serving as an independent contractor for Rottapharm and Kadmon, and speaking and teaching for the Geneva Foundation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
FROM THE LIVER MEETING 2014
VIDEO: Pediatric NAFLD worsens as kids age
BOSTON – Pediatric nonalcoholic fatty liver disease progresses as children age to a more adult pattern of disease, a paired-biopsy study shows.
“As they grow older, they are facing liver transplant and potentially hepatocellular carcinoma, just as the adults do,” Dr. Elizabeth M. Brunt said during an interview at the annual meeting of the American Association for the Study of Liver Diseases.
Among 102 children studied, the zone 1 (borderline 1b) diagnostic pattern decreased from 27.5% to 9.8%, while the more “adult” NAFLD zone 3 (borderline 1a) pattern and definite steatohepatitis patterns both increased from 14.7% and 28.4% to 18.6% and 29.4%.
Moreover, cirrhosis was seen in nearly 3% of children at first biopsy, but by the second biopsy, nearly 20% of children had advanced fibrosis or cirrhosis, she said.
The findings are troubling because the United States is in the midst of an obesity epidemic, and obesity is associated with high rates of fatty liver disease, said Dr. Brunt of Washington University, St. Louis.
The National Institutes of Health supported the study. Dr. Brunt reported consulting for Synageva, serving as an independent contractor for Rottapharm and Kadmon, and speaking and teaching for the Geneva Foundation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Pediatric nonalcoholic fatty liver disease progresses as children age to a more adult pattern of disease, a paired-biopsy study shows.
“As they grow older, they are facing liver transplant and potentially hepatocellular carcinoma, just as the adults do,” Dr. Elizabeth M. Brunt said during an interview at the annual meeting of the American Association for the Study of Liver Diseases.
Among 102 children studied, the zone 1 (borderline 1b) diagnostic pattern decreased from 27.5% to 9.8%, while the more “adult” NAFLD zone 3 (borderline 1a) pattern and definite steatohepatitis patterns both increased from 14.7% and 28.4% to 18.6% and 29.4%.
Moreover, cirrhosis was seen in nearly 3% of children at first biopsy, but by the second biopsy, nearly 20% of children had advanced fibrosis or cirrhosis, she said.
The findings are troubling because the United States is in the midst of an obesity epidemic, and obesity is associated with high rates of fatty liver disease, said Dr. Brunt of Washington University, St. Louis.
The National Institutes of Health supported the study. Dr. Brunt reported consulting for Synageva, serving as an independent contractor for Rottapharm and Kadmon, and speaking and teaching for the Geneva Foundation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Pediatric nonalcoholic fatty liver disease progresses as children age to a more adult pattern of disease, a paired-biopsy study shows.
“As they grow older, they are facing liver transplant and potentially hepatocellular carcinoma, just as the adults do,” Dr. Elizabeth M. Brunt said during an interview at the annual meeting of the American Association for the Study of Liver Diseases.
Among 102 children studied, the zone 1 (borderline 1b) diagnostic pattern decreased from 27.5% to 9.8%, while the more “adult” NAFLD zone 3 (borderline 1a) pattern and definite steatohepatitis patterns both increased from 14.7% and 28.4% to 18.6% and 29.4%.
Moreover, cirrhosis was seen in nearly 3% of children at first biopsy, but by the second biopsy, nearly 20% of children had advanced fibrosis or cirrhosis, she said.
The findings are troubling because the United States is in the midst of an obesity epidemic, and obesity is associated with high rates of fatty liver disease, said Dr. Brunt of Washington University, St. Louis.
The National Institutes of Health supported the study. Dr. Brunt reported consulting for Synageva, serving as an independent contractor for Rottapharm and Kadmon, and speaking and teaching for the Geneva Foundation.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
FROM THE LIVER MEETING 2014
VIDEO: Will new HCV drugs’ costs kill health care budgets?
BOSTON – The estimated cost of treating all eligible U.S. hepatitis C patients with a new generation of high-priced medications may be breathtaking, but would the resulting savings over those cured patients’ lifetimes offset the initial financial blow?
A new analysis unveiled at the annual meeting of the American Association for the Study of Liver Diseases calculated the impact of the new drugs on treatment costs and compared the cost of treatment with new drugs to the old standard of care.
“We found that the cost of treatment is very high, as expected,” explained lead investigator Jagpreet Chhatwal, Ph.D., of MD Anderson Cancer Center, Houston. In fact, if everyone who was eligible for the new drugs were treated, the cost over the next 5 years would be $136 billion.
“This is clearly unsustainable for any payer,” he noted. “So the question is: How can we manage to treat people who need this treatment?”
In a video interview, Dr. Chhatwal outlined how the researchers calculated their cost estimates, what cost savings could be gained with the new drugs, and how patients and payers alike could manage the price of treatment.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – The estimated cost of treating all eligible U.S. hepatitis C patients with a new generation of high-priced medications may be breathtaking, but would the resulting savings over those cured patients’ lifetimes offset the initial financial blow?
A new analysis unveiled at the annual meeting of the American Association for the Study of Liver Diseases calculated the impact of the new drugs on treatment costs and compared the cost of treatment with new drugs to the old standard of care.
“We found that the cost of treatment is very high, as expected,” explained lead investigator Jagpreet Chhatwal, Ph.D., of MD Anderson Cancer Center, Houston. In fact, if everyone who was eligible for the new drugs were treated, the cost over the next 5 years would be $136 billion.
“This is clearly unsustainable for any payer,” he noted. “So the question is: How can we manage to treat people who need this treatment?”
In a video interview, Dr. Chhatwal outlined how the researchers calculated their cost estimates, what cost savings could be gained with the new drugs, and how patients and payers alike could manage the price of treatment.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – The estimated cost of treating all eligible U.S. hepatitis C patients with a new generation of high-priced medications may be breathtaking, but would the resulting savings over those cured patients’ lifetimes offset the initial financial blow?
A new analysis unveiled at the annual meeting of the American Association for the Study of Liver Diseases calculated the impact of the new drugs on treatment costs and compared the cost of treatment with new drugs to the old standard of care.
“We found that the cost of treatment is very high, as expected,” explained lead investigator Jagpreet Chhatwal, Ph.D., of MD Anderson Cancer Center, Houston. In fact, if everyone who was eligible for the new drugs were treated, the cost over the next 5 years would be $136 billion.
“This is clearly unsustainable for any payer,” he noted. “So the question is: How can we manage to treat people who need this treatment?”
In a video interview, Dr. Chhatwal outlined how the researchers calculated their cost estimates, what cost savings could be gained with the new drugs, and how patients and payers alike could manage the price of treatment.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
FROM THE LIVER MEETING 2014
VIDEO: Hepatitis C screening recommendations falling on deaf ears
BOSTON – The call to screen Baby Boomers for hepatitis C virus infections appears to have gone unheeded so far, results from a Chicago primary care clinic show.
Screening increased by only 2% among some 25,000 patients seen in the primary care clinic of the University of Chicago after the 2012 Centers for Disease Control and Prevention recommendation to screen adults born between 1945 and 1965, Dr. Mansi Kothari reported at the annual meeting of the American Association for the Study of Liver Diseases.
On a positive note, Dr. Kothari of the University of Chicago Medical Center noted in an interview that if a patient tested positive for hepatitis C virus, rates of additional testing and referral to a hepatologist remained high.
Dr. Kothari reported no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – The call to screen Baby Boomers for hepatitis C virus infections appears to have gone unheeded so far, results from a Chicago primary care clinic show.
Screening increased by only 2% among some 25,000 patients seen in the primary care clinic of the University of Chicago after the 2012 Centers for Disease Control and Prevention recommendation to screen adults born between 1945 and 1965, Dr. Mansi Kothari reported at the annual meeting of the American Association for the Study of Liver Diseases.
On a positive note, Dr. Kothari of the University of Chicago Medical Center noted in an interview that if a patient tested positive for hepatitis C virus, rates of additional testing and referral to a hepatologist remained high.
Dr. Kothari reported no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – The call to screen Baby Boomers for hepatitis C virus infections appears to have gone unheeded so far, results from a Chicago primary care clinic show.
Screening increased by only 2% among some 25,000 patients seen in the primary care clinic of the University of Chicago after the 2012 Centers for Disease Control and Prevention recommendation to screen adults born between 1945 and 1965, Dr. Mansi Kothari reported at the annual meeting of the American Association for the Study of Liver Diseases.
On a positive note, Dr. Kothari of the University of Chicago Medical Center noted in an interview that if a patient tested positive for hepatitis C virus, rates of additional testing and referral to a hepatologist remained high.
Dr. Kothari reported no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE LIVER MEETING 2014
