Chronic hepatitis B and C infection in the United States: a review of current guidelines, disease burden and cost effectiveness of screening

Sarpel, Dost; Baichoo, Esha; Dieterich, Douglas T.

doi:10.1586/14787210.2016.1174066

Cited by 16 publications

(16 citation statements)

References 53 publications

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Section: Introductionmentioning

confidence: 99%

“…In the United States there is a reported prevalence of approximately 2.7-3.9 million people chronically infected with HCV (antibody to HCV present with HCV RNA positive) [1][2][3] . The true prevalence when underreported populations are taken into account likely is between 5-7 million people [1] . Chronic Hepatitis C (CHC) is often an asymptomatic infection that can go years undetected, indeed the majority of chronically infected patients are not aware of their infection [3,4] .…”

Section: Introductionmentioning

confidence: 99%

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Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

Rutledge

Mahajan

Naylor

et al. 2017

Journal of Gastroenterology and Hepatology Research

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INTRODUCTION: There is considerable uncertainty with respect to predicting the liver disease status of African American (AA) patients with Hepatitis C seen in the current era of highly effective direct acting anti-virals (DAA). This uncertainty is due to the complex interplay between the identification of patients early in their disease progression by screening, the fact that many AA patients failed earlier interferon based therapy, duration of the HCV viremia in AA patients, the possible variation In disease course in AA as compared to other races, and potential early mortality of AA patients due to liver disease. Understanding the evolution of HCV infection as defined by comparing previous and current patient populations provides information relevant to both therapeutic and health costs decisions. METHODS: We selected patients from a 24 month period between 2002 and 2003 (Epoch 1; n = 414) to compare with patients seen in the same GI clinic between 2012 and 2013 (Epoch 2; n=405). Epoch 1 was the beginning of the peg-interferon and ribavirin treatment era and Epoch 2 reflects the patient population seen when DAA therapy was first available. RESULTS: Epoch 2 patients were older (59.7 vs 50.3 years) with a similar gender distribution (55% vs 59% male). Consistent with the change in clinic demographics, more AA patients were seen in Epoch 2 (89%) as compared to Epoch 1 (77%). There was no significant difference between hepatic fibrosis as assessed by APRI (1.1 vs 0.9) or FIB-4 (2.4 vs 2.6) but there was an increase in intermediate degree of fibrosis as defined by liver biopsy. The majority of Epoch 2 patients were still naïve to treatment (96% Epoch 1 vs 61% Epoch 2) and a similar proportion had cirrhosis (15% Epoch 1 vs 17% Epoch 2) at the time of first visit in the different time periods. CONCLUSIONS: The patients in Epoch 2 from this urban GI referral clinic are older and the majority of them had not been treated or had not responded to treatment. This age demographic continues to reflect patients who were likely infected during the 1960's-1980's which is when HCV infection became widespread. Epoch 2 patients also do not have more advanced liver disease as defined either by significant fibrosis or cirrhosis as compared to Epoch 1. Possible explanations include that Epoch 2 patients' disease was detected earlier by surveillance, progressed very slowly to advanced liver disease, or had a high mortality that resulted in a decline in patients with advanced disease. The role of access to therapy in patients not treated remains to be determined and the increased effectiveness of DAA are predicted to increase the number of AA patients seeking and accepting treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

Rutledge

Mahajan

Naylor

et al. 2017

Journal of Gastroenterology and Hepatology Research

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“…In its most recent updated recommendation in 2009, the United States Preventive Services Task Force (USPSTF) advised that HBV vaccination is effective at lowering infection risk in high-risk populations [ 4 ]. While the cost effectiveness of HBV screening among the general population is under debate [ 5 , 6 ], HBV vaccination among foreign born adult immigrants is considered to be vital. A cost-effective analysis comparing several HBV screening and vaccination strategies among Asian and Pacific Islander adults found a screen, treat, and ring vaccination strategy was highly cost effective [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial

et al. 2016

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BackgroundThis study aimed to evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations among foreign-born Asian Americans in the Baltimore-Washington Metropolitan area.MethodsDuring the period of April 2013 and March 2014, we recruited Asian Americans who were 18 years of age and older in the community-based organizations. Of the 645 eligible participants, 600 (201 Chinese, 198 Korean, 201 Vietnamese) completed a pretest survey and received hepatitis B screening. Based on the screening results, we conducted a randomized controlled trial among those unprotected (HBsAg-/HBsAB-) by assigning them either to an intervention group (n = 124) or control group (n = 108). The intervention group received a list of resources by mails for where to get free vaccinations as well as reminder calls for vaccinations from trained LHWs, while the control group received only list of resources by mail. Seven months after mailing the HBV screening results, trained LHWs followed up with all participants by phone to ask how many of the recommended series of 3 vaccinations they had received: none, 1 or 2, or all 3 (complete). Their self-reported vaccinations were verified with the medical records. Multinomial logistic regressions were used to examine the effect of the LHW intervention. Process evaluation was conducted by asking study participants in the intervention group to evaluate the performance of the LHWs.ResultsAfter seven months, those in the intervention group were more likely to have 1 or more vaccines than the control group, compared to the no vaccination group (OR = 3.04, 95% CI, 1.16, 8.00). Also, those in the intervention group were more likely to complete a series of vaccinations than the control group, compared to the no vaccination group (OR = 7.29, 95% CI 3.39, 15.67). The most important barrier preventing them from seeking hepatitis B vaccinations was lack of time to get the vaccination. The most important promoters to getting vaccinations, among those who had vaccinations (n = 89), were our intervention program (70.8%) and self-motivation (49.4%). The majority of participants in the intervention group received the phone calls from LHWs (93%) and almost all of them got the reminder to receive vaccines (98%).ConclusionThe LHW intervention was successful at increasing HBV vaccinations rates among foreign-born Asian Americans. This study suggests that this culturally integrated intervention program may be useful for reducing liver cancer disparities from chronic HBV infection in high risk Asian Americans.Trial RegistrationClinicalTrials.gov NCT02760537

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“…It is well documented in the literature that for many chronic diseases, treatment non-adherence is associated with increased morbidity, mortality (5.9%), and substantial increased costs (ranging from $5271 to $52,341) [39,40]. However, published literature regarding CHB is systematic reviews; direct comparisons to our study results are challenging because of differences in the study populations, study design, and/or varying definitions of persistence and adherence [41][42][43].…”

Section: Discussionmentioning

confidence: 91%

Evaluating the Effect of Standard of Care Treatment on Burden of Chronic Hepatitis B: A Retrospective Analysis of the United States Veterans Population

et al. 2020

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Introduction: This study aimed to characterize chronic hepatitis B (CHB)-infected patients and estimate the association between nucleos(t)ide analogue (NA) persistence and economic outcomes using data from the Veterans Health Administration (VHA) database. Methods: Patients (at least 18 years of age) with two or more claims for CHB and at least one pharmacy claim for NA were identified using VHA data from 1 April 2013 to 31 March 2018. The index date was the first NA prescription fill date during 1 October 2014 to 31 March 2017. Persistence and non-persistence to NA treatment were assessed during the first 2 years post index date. Non-persistence was defined as at least one failure to refill medication within 30 days from the run-out date. Generalized linear models were used to compare health care utilization and costs between persistent and non-persistent patients. Results: Among patients treated with NAs (N = 2368), 1428 (60%) were CHB mono-infected and 748 (32%) were HIV co-infected.

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Chronic hepatitis B and C infection in the United States: a review of current guidelines, disease burden and cost effectiveness of screening

Cited by 16 publications

References 53 publications

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial

Evaluating the Effect of Standard of Care Treatment on Burden of Chronic Hepatitis B: A Retrospective Analysis of the United States Veterans Population

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