Chizoba Nwankwo

Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach

OBJECTIVE To assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States. METHODS We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practicess previous regional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Health and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980-1995). We used a societal perspective and projected costs (in 2013 US

Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States

), quality-adjusted life-years, incremental cost-effectiveness ratio, and other outcomes over the period 2006 to 2106. RESULTS On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an incremental cost-effectiveness ratio of

Cost-Utility of Elbasvir/Grazoprevir in Patients with Chronic Hepatitis C Genotype 1 Infection

21,223/quality-adjusted life-year when herd protection was ignored. CONCLUSIONS Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality, morbidity, and cost-effectiveness ratios.

Epidemiology of hepatitis C virus infection in a large Israeli health maintenance organization.

Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once‐daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost‐effectiveness of EBR/GZR in treatment‐naïve and treatment‐experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg‐IFN/RBV) using a computer‐based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000–2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg‐INF/RBV were based on wholesale acquisition cost. All costs were from a third‐party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver‐related complications, liver transplantation, kidney transplantation, end‐stage live disease mortality and end‐stage renal disease mortality; lifetime quality‐adjusted life years (QALY); and incremental cost‐utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver‐related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg‐IFN/RBV. EBR/GZR‐based regimens resulted in higher average remaining QALYs and higher costs (11.5716,

Confluence of Epidemics of Hepatitis C, Diabetes, Obesity, and Chronic Kidney Disease in the United States Population

191 242) compared with NoTx (8.9199,

Real-World Data on Multiple Comorbidities Among Patients With Hepatitis C: Considerations for Patient Care And Prognosis.

156 236) or peg‐INF/RBV (10.2857,

HEPATITIS C PREVALENCE AND CLINICAL OUTCOMES IN THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

186 701). Peg‐IFN/RBV is not cost‐effective, and the ICUR of EBR/GZR compared with NoTx was

Evidence-to-policy gap on hepatitis A vaccine adoption in 6 countries: Literature vs. policymakers' beliefs

13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR (

Characterisitcs and Drug Utilization among Treated Chronic Hepatitis C Virus (Chc) Patients with and without Chronic Kidney Disease (Ckd) in the Us

217 000/QALY). Assuming a threshold of

Projected Clinical And Economic Impact Of Grazoprevir (Gzr, Mk-5172)/Elbasvir (Ebr, Mk-8742) For Chronic Hcv Genotype 1 Infection In Chronic Kidney Disease

100 000 per QALY gained for cost‐effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost‐effective in the United States.