Leyla de Avila

Direct and Indirect Economic Burden of Chronic Liver Disease in the United States

Background & Aims Chronic liver (CLD) is a major public health concern. We assessed its effects on quality of life and work productivity, as well as its economic burden in the United States. Methods We performed a cross‐sectional study of data from the Medical Expenditure Panel Survey (MEPS; 2004–2013). We extracted participants’ sociodemographic parameters and medical histories. Subjects with CLD were identified based on Clinical Classification Software codes. MEPS participants were compared between those with and without CLD, and then between employed and unemployed patients with CLD. Outcomes were quality‐of‐life scores, employment, and health care use. Results We collected data from 230,406 adult participants (age, ≥18 y) in the MEPS; 1846 had current CLD (36.7% with viral hepatitis and 5.3% with liver cancer). Individuals with CLD were less likely to be employed (44.7% vs 69.6% patients without CLD), were not working owing to illness/disability (30.5% vs 6.6% without CLD), lost more work because of disability (10.2 vs 3.4 d without CLD), and had more health care use, producing greater health care expenses (

Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD).

19,390 vs

Hepatitis C Virus–Infected Patients Receiving Opioid Substitution Therapy Experience Improvement in Patient-Reported Outcomes Following Treatment With Interferon-Free Regimens

5567/y without CLD) (all P < .0001). Patients with CLD also had more comorbidities and worse self‐reported general and mental health status, and reported more health‐related limitations in their daily activities than individuals without CLD (all P < .0001). They also indicated more psychologic distress and depressive symptoms and had a lower quality of life and health utility scores (P < .0001). In multivariate analysis, after adjustment for sociodemographic factors and comorbidities, the presence of CLD was an important predictor of unemployment (odds ratio, 0.60; 95% confidence interval, 0.50–0.70), annual health care expenditure (&bgr; =

Long-term outcomes of liver transplantation in patients with hepatitis C infection are not affected by HCV positivity of a donor

9503 ±

Cognitive Performance in Individuals With NonAlcoholic Fatty Liver Disease and/or Type 2 Diabetes Mellitus

2028), and impairment in all aspects of health‐related quality of life (all P < .0001). In patients with CLD, the presence of liver cancer had the most profound impact on health care expenditures (&bgr; =

881 - Insurance Coverage and Mortality in Patients with Hepatitis C Virus (HCV) Infection in the United States (U.S.)

17,278 ±

Su1525 - Cognitive Function and Depression in Individuals with Nonalcoholic Fatty Liver Disease (NAFLD) and type 2 Diabetes Mellitus (T2DM): Analysis of the 2011–2014 National Health and Nutrition Examination Survey (NHANES)

5726/y) and physical health (&bgr; = ‐7.2 ± 1.7 for SF‐12 physical component) (all P < .005). Conclusions In a cross‐sectional analysis of MEPS participants, we associated CLD with large economic and quality‐of‐life burdens.

Psoriasis is Independently Associated with Non-Alcoholic Fatty Liver Disease

Abstract Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Metabolic syndrome (MS) components are highly prevalent in NAFLD. Our aim is to assess the relationship of NAFLD and MS with long-term outcome of mortality. The Third National Health and Nutrition Examination Survey (NHANES) was utilized. NAFLD was diagnosed by ultrasound in the presence of hepatic steatosis and no other causes of chronic liver disease. History of MS and its components were obtained from self-reported NHANES questionnaires. Mortality was obtained from Mortality-Linkage File, through December 31, 2011. Chi-square test was used for categorical variables and Cox proportional models estimated hazard ratios with 95% confidence interval. NAFLD cohort (n = 3613) had a median age of 43 years, 73% white, and 50% male. NAFLD group with at least one MS condition was significantly older, had higher body mass index, more likely to have insulin resistance, and heart disease compared to NAFLD group without MS. Over 19-years of follow-up, 1039 people died. Compared to NAFLD patients without MS, presence of one MS component increased the risk of mortality at 8-year (2.6% vs 4.7%) and 16-year (6% vs 11.9%) (P < .001). After adjusting for socio-demographic factors, NAFLD with all MS components was associated with overall, cardiac and liver-mortality. Increased number of MS components was associated with lower survival (P < .0001). Patients with NAFLD and MS have higher mortality risk compared to NAFLD patients without MS. These NAFLD patients should be prioritized for the development of treatment regimens.

Outcomes of Wait-Listed Liver Transplant (LT) Candidates with Chronic Liver Disease (CLD) in the United States: The Impact of Model of End Stage Liver Disease (MELD) Scores and Disease Etiology

Background There is a paucity of patient-reported outcomes (PROs) data for people undergoing hepatitis C virus (HCV) treatment who are treated with opioid substitution therapy (OST) for addiction. Methods Patients enrolled in phase 3 clinical trials of sofosbuvir completed 4 PRO instruments-SF-36v2, FACIT-F, CLDQ-HCV, and WPAI-HCV-before, during, and after treatment. Results A total of 8450 HCV-infected subjects were included; 4.8% (407) were receiving OST. At baseline, OST recipients had significantly (P < .0001) lower PRO scores (by -3.5 to -15.6 on a 0-100 scale). By the end of treatment, subjects receiving pegylated interferon, ribavirin, and sofosbuvir (IFN+RBV+SOF) experienced significant decreases in PROs regardless of OST use. Subjects receiving IFN-free RBV-containing regimens had significant but smaller PRO decreases, again similar in the OST and non-OST groups. Finally, subjects treated with regimens free of both IFN and RBV (IFN/RBV-free) showed improvements in nearly all PROs during treatment, with improvements more pronounced in OST recipients. Achieving a sustained virological response for 12 consecutive weeks after treatment cessation (SVR-12) was associated with improvement of PROs in OST recipients treated with IFN/RBV-free regimens. In contrast, OST recipients who achieved SVR-12 with IFN+RBV+SOF did not have consistent PRO gains after the SVR-12. Conclusions Receiving IFN-free regimens leads to PRO improvement during treatment and after the SVR-12, regardless of OST status. HCV-infected subjects receiving OST did not experience similar PRO improvements with IFN-containing therapy, suggesting that IFN-based therapy may be less suitable for this vulnerable population.