Hla-Hla Thein

Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression.

Published estimates of liver fibrosis progression in individuals with chronic hepatitis C virus (HCV) infection are heterogeneous. We aimed to estimate stage‐specific fibrosis progression rates and their determinants in these individuals. A systematic review of published prognostic studies was undertaken. Study inclusion criteria were as follows: (1) presence of HCV infection determined by serological assays; (2) available information about age at assessment of liver disease or HCV acquisition; (3) duration of HCV infection; and (4) histological and/or clinical diagnosis of cirrhosis. Annual stage‐specific transition probabilities (F0→F1, … , F3→F4) were derived using the Markov maximum likelihood estimation method and a meta‐analysis was performed. The impact of potential covariates was evaluated using meta‐regression. A total of 111 studies of individuals with chronic HCV infection (n = 33,121) were included. Based on the random effects model, the estimated annual mean (95% confidence interval) stage‐specific transition probabilities were: F0→F1 0.117 (0.104–0.130); F1→F2 0.085 (0.075–0.096); F2→F3 0.120 (0.109–0.133); and F3→F4 0.116 (0.104–0.129). The estimated prevalence of cirrhosis at 20 years after the infection was 16% (14%–19%) for all studies, 18% (15%–21%) for cross‐sectional/retrospective studies, 7% (4%–14%) for retrospective‐prospective studies, 18% (16%–21%) for studies conducted in clinical settings, and 7% (4%–12%) for studies conducted in nonclinical settings. Duration of infection was the most consistent factor significantly associated with progression of fibrosis. Conclusion: Our large systematic review provides increased precision in estimating fibrosis progression in chronic HCV infection and supports nonlinear disease progression. Estimates of progression to cirrhosis from studies conducted in clinical settings were lower than previous estimates. (HEPATOLOGY 2008.)

Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: a meta-analysis.

Objectives:To estimate stage-specific transition probabilities in individuals coinfected with HIV and hepatitis C virus (HCV), to examine the effect of covariates on these rates, and to investigate the effect of HIV on HCV-related cirrhosis in the era of highly active antiretroviral therapy (HAART). Design:Systematic review of natural history studies among HCV-infected individuals. Methods:Markov maximum likelihood estimation method was used to estimate stage-specific transition probabilities. A meta-analysis was performed to obtain pooled transition probabilities, and a meta-regression to investigate the impact of covariates on these rates. Risk of cirrhosis between individuals monoinfected with HCV and coinfected with HIV/HCV were compared by HAART status. Results:The estimated mean (95% confidence intervals) annual transition probabilities of 3567 individuals coinfected with HIV/HCV (n = 17 studies) were as follows: fibrosis stage (F) F0 → F1 0.122 (0.098–0.153); F1 → F2 0.115 (0.095–0.140); F2 → F3 0.124 (0.097–0.159); and F3 → F4 0.115 (0.098–0.135) units/year. The prevalence of cirrhosis after 20 and 30 years of HCV infection was 21% (16–28%) and 49% (40–59%), respectively. Longer duration of HCV infection was significantly associated with slower rate of fibrosis progression. The overall rate ratio of cirrhosis between individuals coinfected with HIV/HCV and monoinfected with HCV (n = 27 studies) was 2.1 (1.5–3.0), 2.5 (1.8–3.4) in the non-HAART group, and 1.7 (1.1–2.8) in the HAART group. Conclusion:The rate of fibrosis progression among individuals coinfected with HIV/HCV appears constant. Our results confirm that chronic hepatitis C outcomes are worse among coinfected individuals. Over the period studied, HAART did not appear to fully correct the adverse effect of HIV infection on HCV prognosis.

Estimation of Utilities for Chronic Hepatitis C from SF-36 Scores

OBJECTIVES:Utilities are the recommended health-related quality of life (HRQOL) measure for cost-effectiveness studies. The aim of this study was to estimate utilities for chronic hepatitis C health states from published studies reporting Short Form-36 (SF-36) quality-of-life scores.METHODS:A systematic review of published studies was undertaken. Articles were eligible for review if direct HRQOL assessment using the SF-36 in a chronic hepatitis C population was reported. SF-36 data were grouped according to hepatitis C virus (HCV) treatment status at baseline, stage of liver disease, association with comorbidity, and HCV treatment response. The SF-36 scores were then transformed into utilities using three different methods.RESULTS:Using Nichols method, the estimated SF-36 mean utilities were 0.87 for sustained virological response (SVR) to interferon-based treatment, 0.82 for untreated chronic hepatitis C, 0.81 for precirrhosis, 0.76 for compensated cirrhosis, 0.69 for decompensated cirrhosis, 0.67 for hepatocellular carcinoma (HCC), and 0.77 for liver transplant. Other methods showed differences across comparison groups (e.g., treated vs untreated) but absolute scores differed substantially by translation method. SF-36 utilities for different stages of liver disease varied considerably from expert estimates but comparable to direct patient-elicited utilities.CONCLUSIONS:Application of SF-36 translation methods facilitate use of large existing datasets to generate community-weighted utilities for cost-effectiveness analyses, an important consideration in the absence of large studies of direct patient-elicited utilities in chronic hepatitis C.

Estimating the cost-effectiveness of needle-syringe programs in Australia.

Objective:To evaluate the impact and cost-effectiveness of needle-syringe programs (NSPs) with respect to HIV and hepatitis C virus (HCV) infections among Australian injecting drug users (IDUs). Design/methods:A health economic analysis was conducted incorporating a mathematical model of HIV and HCV transmission among IDUs. An empirical relationship between syringe availability and receptive syringe sharing (RSS) was assessed. We compared the epidemiological outcomes and costs of NSP coverage (status quo RSS of 15–17%) with scenarios that had no NSPs (RSS of 25–50%). Outcomes included numbers of HIV and HCV infections averted, lifetime health sector costs, and cost per quality-adjusted life year (QALY) gained. Discounting was applied at 3% (sensitivity: 0%, 5%) per annum. Results:We estimated that NSPs reduced incidence of HIV by 34–70% (192–873 cases) and HCV by 15–43% (19 000–77 000 cases) during 2000–2010, leading to 20 000–66 000 QALYs gained. Economic analysis showed that NSP coverage saved A

Improved cognitive function as a consequence of hepatitis C virus treatment

70–220 million in healthcare costs during 2000–2010 and will save an additional A

Trends in mortality after diagnosis of hepatitis B or C infection: 1992–2006

340–950 million in future healthcare costs. With NSPs costing A

Risk factors for hepatocellular carcinoma in a cohort infected with hepatitis B or C.

245 million, the programs are very cost-effective at A

Trends in incidence of hepatocellular carcinoma after diagnosis of hepatitis B or C infection: a population-based cohort study, 1992-2007.

416–8750 per QALY gained. Financial investment in NSPs over 2000–2010 is estimated to be entirely recovered in healthcare cost savings by 2032 with a total future return on investment of

Cognitive function, mood and health-related quality of life in hepatitis C virus (HCV)-monoinfected and HIV/HCV-coinfected individuals commencing HCV treatment*

1.3–5.5 for every

Experience of hepatitis C testing among injecting drug users in Sydney, Australia.

1 invested. Conclusion:Australias early introduction and high coverage of NSPs has significantly reduced the prevalence of HIV and HCV among IDUs. NSPs are a cost-effective public health strategy and will result in substantial net cost savings in the future.