No abstract

ObjectiveHCV infection is a leading cause of chronic liver disease with long-term complications—extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital “Queen Joanna-ISUL” for 3-year period (2012–2014).MethodsIt is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital “Queen Joanna-ISUL” for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy) were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF), hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal–Wallis, and Friedman tests were used for statistical processing.Results76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839) with an average cost per patient 4,577 BGN (€2,340). Statistically significant correlation was observed between the total cost per patient from the different payers’ perspective and the Child-Pugh cirrhosis score.ConclusionHCV-related cirrhosis is resource demanding and sets high direct medical costs as it is related with increased hospitalizations and complications acquiring additional treatment.

The aim of this study was to investigate the clinical efficacy (sensitivity,  specificity) of ultrasound-based imaging methods for the assessment of fibrosis and steatosis in patients with non-àlcoholic fatty liver disease (NAFLD). Sixty-six patients with NAFLD and 43 healthy volunteers (control group) were tested. Liver biopsy was used as a reference method for the evaluation of NAFLD. Liver stiffness measurement (LSM) with transient elastography (TE) and two-dimensional shear wave elastography (2D-SWE) was used to assess fibrosis. Steatosis was assessed by Controlled Attenuation Parameter (CAP) and EchoLevels (ELs). Using the ELs, two hepato-renal indices were calculated – the hepato-renal index difference (HRIdiff) and hepato-renal index ratio (HRIratio). Additionally, one serum biomarker was calculated – APRI. Cut-offs of cirrhosis (F4) were defined as follows: ≥ 9.64 kPa and ≥ 9.85 kPa for 2D-SWE and TE. Only 2D-SWE had a correlation for significant fibrosis – the cut-off was ≥ 6.50 kPa and for lack of significant fibrosis (F < 2) less than 5.26 kPa. Steatosis was diagnosed with a cut-off of 240.50 dB/m for CAP, and HRIdiff ≥ 0.39, and HRIratio ≤ 0.99 for ELs. Both types of SWE and the two methods for evaluation of ultrasound (US) attenuation have good correlation with fibrosis and steatosis in NAFLD.

Data from Bulgaria are limited on the long-term effects of nucleo(s)tide analogues (NAs) to patients with hepatitis B-related cirrhosis. The study aimed to evaluate the overall efficacy and renal safety of NAs in such cohort of patients, comparing treated with high to low-barrier NAs. We retrospectively analyzed 58 patients with HBV cirrhosis (74.1% in compensated stage) for a period of 5 years. Thirty-five patients received NAs with high-barrier of resistance: Tenofovir disoproxil fumarate and Entecavir (followed up for 51.63 ± 30.3) and 23 received NAs with low-barrier of resistance: Lamivudine and Telbivudine (followed up for 56.7 ± 48.4). After a median treatment time of 53.7 months virological response (VR) rates (HBV DNA<10 IU/ml) were 91.4% in high barrier and 87.0% in low barrier NAs groups. Undetectability of HBVDNA was influenced most by the treatments’ duration. Serological response reached 57.1%, similar for the two treatment groups. One patient (1.7%) cleared HBsAg and discontinued NAs (TDF). Multidrug resistance (MDR) occurred in 15.5% of LAM recipients only. One-, 3-, 5-, 8- year MDR rates were 0.0%; 11.1%; 33.3% and 77.6%. A slight improvement of the renal function was observed in 85.7% and 69.6% of the patients treated with high and low-barrier NAs. Dose reduction for renal toxicity was required in 1.7%. Decompensated cirrhosis and T2DM were the main risk factors for renal function decline. Long-term therapy with high and low barrier NAs was equally effective and renally safe in patients with HBV-related cirrhosis.