Tag Archives: fibrosis

French Study Finds Universal HCV Screening Cost Effective

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

In May 2016, the World Health Organization (WHO) adopted a goal of eliminating Hepatitis B (HBV) and C (HCV) by 2030.  Some major nations are on the way to achieving that goal (Australia, for instance); others, like the U.S., are not. One reason why the U.S. is falling so far behind others is that we frequently fail to identify patients who are infected with HCV because the screening guidelines are woefully outdated, focusing primarily on “one-time testing” for patients in the Birth Cohort (those born between 1945-1965) and patients whose doctors knowthey use or have used injection drugs.

Journal of Hepatology

Photo Source: EASL

A new study out of France, however, has found that a combination of universal screening for and immediate treatment of HCV was the most cost-effective way to combat the virus. The study, published in the Journal of Hepatology, found that, using their model which did away with “highest risk” screening models like the one used in the U.S., reduced the incidence of hepatic events (i.e. – cirrhosis, decompensated cirrhosis, and liver-related mortality) in undiagnosed adults over the age of 18. The model also considered treatment initiation for all patients with fibrosis scores of 2 or higher, which resulted in reduced Chronic HCV prevalence in one year’s time; treatment initiation regardless of fibrosis score decreased prevalence significantly. A Healio article on this study has a much better explanation of the findings than the Journal of Hepatologysummary, and it can be found at this link:

https://www.healio.com/hepatology/hepatitis-c/news/online/%7B7c00ba17-af2b-4ddb-b0b2-26c8d6fed926%7D/universal-hcv-screening-in-adults-cost-effective-decreases-prevalence

While universal screening and treatment likely would be cost-effective in France (as well as other countries that offer Universal Healthcare), I predict that it would be incredibly difficult to replicate that finding here, in the U.S., primarily because of the way our for-profit healthcare system is structured. Between being constantly (and increasingly) bilked by private insurers and pharmaceutical companies, and the resultant exorbitant costs of testing and treatment, the U.S. is not currently positioned to adopt this strategy. In order for this strategy to be successful, the U.S. would have to fundamentally overthrow the existing healthcare payor model and adopt an intelligent policy of universal provision – an unlikely occurrence given the current legislative and executive political makeup.

That said, there is little stopping better prepared and positioned nations from adopting this strategy, and ensuring that their nations are able to eliminate HCV by 2030.

References:

  • Deuffic-Burban, S., Huneau, A., Verleene, A., Brouard, C., Pillonel, J., Le Strat, Y., Cossais, S., et. al. (2018, July 01). Assessing the cost-effectiveness of hepatitis C screening strategies in France. Journal of Hepatology. https://doi.org/10.1016/j.jhep.2018.05.027

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Advances and Risks for Hepatitis C Patients

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

As our understanding of the Hepatitis C Virus (HCV) increases, we learn more about how the virus affects our bodies and well as develop better diagnostic and treatment tools to screen for and mitigate the comorbidities that arise from untreated HCV. New technologies can be used to test liver fibrosis without invasive biopsy tools – which remain the most effective way to measure liver damage and scarring (fibrosis) – with a high degree of accuracy…under certain conditions. Additionally, further research has indicated that, in addition to the deleterious effects of HCV on the liver, when left untreated, HCV can result in Chronic Kidney Disease (CKD).

Virtual Touch image of the kidney

Photo Source: Siemens

Virtual Touch™ Quantification (VTQ – Siemens) is a noninvasive diagnostic procedure that allows patients to undergo various types of tissue analyses without the need for surgery or biopsies using Acoustic Radiation Force Impulse (ARFI) – a sonographic technique that determines the local mechanical properties of tissue (a fancy way of saying “stiffness”). Essentially, much like an ultrasound during pregnancy, ARFI and VTQ uses a conventional ultrasound probe during abdominal ultrasonography to measure the stiffness of the liver. This is especially effective in patients with ascites – an accumulation of protein-containing (ascitic) fluid within the abdomen – an advancement over the Fibroscan (Transient Elastography – Echosens) which cannot (Bennett, 2018).

The research (Tsukano, et al., 2017) also indicates that skin liver capsule distance (SCD) – the distance between the skin and the liver capsule – corresponded highly with any discrepancies between VTQ and liver biopsy analyses. Patients with a long SCD may receive less accurate results using VTQ. Steatosis, hepatic inflammation, and hepatocyte ballooning have little effect on ARFI measurement failures (Bennett).

Chronic Kidney Disease stages

Photo Source: Sunlight Pharmacy

Another study (Park, et al., 2017) discovered that patients with HCV are at higher risk of developing CKD. The research found that Chronic HCV is associated with extrahepatic manifestations – problems that occur outside the liver, some of which are associated with the immune system, and others seem to be driven by chronic inflammation – with CKD being the most commonly reported extrahepatic condition. Untreated Chronic HCV leads to a 27% increase for developing CKD, while treating the disease using Interferon-based dual, triple, and all-oral Direct Acting Antivirals (DAAs) had a 30% reduction in risk for developing CKD. The researchers indicated that they were “disturbed” to find that 79% of patients with Chronic HCV did not receive treatment (van Paridon, 2018). The increased risk of CKD was more significant in patients age 18-49, compared to adults aged 60≥.

While more research is needed, this should serve as a caution to payors and legislators who have been reluctant to approve treatment methods for HCV patients due to associated short-term expenditures.

References

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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