Kee Chan

Cost Effectiveness of Direct-Acting Antiviral Therapy for Treatment-Naive Patients With Chronic HCV Genotype 1 Infection in the Veterans Health Administration

BACKGROUND & AIMS The Veterans Health Administration (VHA) is the largest single provider of care for hepatitis C virus (HCV) infection in the United States. We analyzed the cost effectiveness of treatment with the HCV protease inhibitors boceprevir and telaprevir in a defined managed care population of 102,851 patients with untreated chronic genotype 1 infection. METHODS We used a decision-analytic Markov model to examine 4 strategies: standard dual-therapy with pegylated interferon-alfa and ribavirin (PR), the combination of boceprevir and PR triple therapy, the combination of telaprevir and PR, or no antiviral treatment. A sensitivity analysis was performed. Sources of data included published rates of disease progression, the census bureau, and VHA pharmacy and hospitalization cost databases. RESULTS The estimated costs for treating each patient were

Budget Impact Analysis of HIV Testing in the VA Healthcare System

8000 for PR,

Implementing an HIV Rapid Testing–Linkage-to-Care Project Among Homeless Individuals in Los Angeles County: A Collaborative Effort Between Federal, County, and City Government

31,300 for boceprevir and PR, and

Comparative Logic Modeling for Policy Analysis: The Case of HIV Testing Policy Change at the Department of Veterans Affairs

41,700 for telaprevir and PR. Assuming VHA treatment rates of 22% and optimal rates of sustained virologic response, PR, boceprevir and PR, and telaprevir and PR would reduce relative liver-related deaths by 5.2%, 10.9%, and 11.5%, respectively. Increasing treatment rates to 50% would reduce liver-related deaths by 12%, 24.7%, and 26.1%, respectively. The incremental cost-effectiveness ratios were

No Clinic Left Behind: Providing Cost‐Effective In‐Services Via Distance Learning

29,184/quality-adjusted life-years for boceprevir and PR and

HIV Rapid Testing in a VA Primary Care Department Setting: Programmatic Cost Analysis at Five Years

44,247/quality-adjusted life-years for telaprevir and PR vs only PR. With the current 22% treatment rate, total system-wide costs to adopt boceprevir and PR or telaprevir and PR would range from

Interactive Internet-Based Clinical Education: An Efficient and Cost-Savings Approach to Point-of-Care Test Training

708 to

Single-incision laparoscopic cholecystectomy: from four wounds to one

943 million. CONCLUSIONS Despite substantial up-front costs of treating HCV-infected patients in the VHA with PR, or telaprevir and PR, each regimen improves quality of life and extends life expectancy by reducing liver-related morbidity and mortality, and should be cost effective. Further efforts to expand access to direct-acting antiviral therapy are warranted.

Comparative Cost Analysis of Clinical Reminder for HIV Testing at the Veterans Affairs Healthcare System

OBJECTIVES The long-term cost effectiveness of routine HIV testing is favorable relative to other medical interventions. Facility-specific costs of expanded HIV testing and care for newly identified patients, however, are less well defined. To aid in resource allocation decisions, we developed a spreadsheet-based budget-impact tool populated with estimates of facility-specific HIV testing and care costs incurred with an expanded testing program. METHODS We modeled intervention effects on quarterly costs of antiretroviral therapy (ART), outpatient resource utilization, and staff expenditures in the Department of Veterans Affairs over a 2-year period of increasing HIV testing rates. We used HIV prevalence estimates, screening rates, counseling, positive tests, Veterans Affairs treatment, and published sources as inputs. We evaluated a single-facility cohort of 20,000 patients and at baseline assumed a serodiagnostic rate of 0.45%. RESULTS Expanding testing from 2% to 15% annually identified 21 additional HIV-positive patients over 2 years at a cost of approximately

ImplementinganHIVRapidTesting-Linkage-to-Care ProjectAmongHomelessIndividualsinLosAngeles County:ACollaborativeEffortBetweenFederal, County,andCityGovernment

290,000, more than 60% of which was due to providing ART to newly diagnosed patients. While quarterly testing costs decreased longitudinally as fewer persons required testing, quarterly ART costs increased from