Monica Schmidt

Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States

BACKGROUND & AIMS Gastrointestinal (GI), liver, and pancreatic diseases are a source of substantial morbidity, mortality, and cost in the United States. Quantification and statistical analyses of the burden of these diseases are important for researchers, clinicians, policy makers, and public health professionals. We gathered data from national databases to estimate the burden and cost of GI and liver disease in the United States. METHODS We collected statistics on health care utilization in the ambulatory and inpatient setting along with data on cancers and mortality from 2007 through 2012. We included trends in utilization and charges. The most recent data were obtained from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the National Cancer Institute. RESULTS There were 7 million diagnoses of gastroesophageal reflux and almost 4 million diagnoses of hemorrhoids in the ambulatory setting in a year. Functional and motility disorders resulted in nearly 1 million emergency department visits in 2012; most of these visits were for constipation. GI hemorrhage was the most common diagnosis leading to hospitalization, with >500,000 discharges in 2012, at a cost of nearly

Safety and efficacy of sofosbuvir-containing regimens in hepatitis C-infected patients with impaired renal function

5 billion dollars. Hospitalizations and associated charges for inflammatory bowel disease, Clostridium difficile infection, and chronic liver disease have increased during the last 20 years. In 2011, there were >1 million people in the United States living with colorectal cancer. The leading GI cause of death was colorectal cancer, followed by pancreatic and hepatobiliary neoplasms. CONCLUSIONS GI, liver and pancreatic diseases are a source of substantial burden and cost in the United States.

Clostridium difficile testing algorithms: What is practical and feasible?

Renal clearance is the major elimination pathway for sofosbuvir (SOF). We assessed the safety and efficacy of SOF‐containing regimens in patients with varying baseline estimated glomerular filtration rate (eGFR).

LP08 : Safety and efficacy of sofosbuvir-containing regimens in hepatitis C infected patients with reduced renal function: Real-world experience from HCV-target

There has been renewed interest in the laboratory diagnosis of Clostridium difficile infections due in large measure to the increase in both numbers and severity of cases of this disease. For the past two decades, enzyme-immunoassays (EIAs) for the detection of first C. difficile toxin A and then toxins A and B have been the most widely used diagnostic test for diagnosis of C. difficile infections. Recently this diagnostic approach has been called into question by the recognition that a screening test which detects glutamate dehydrogenase, a cell wall antigen of C. difficile, was significantly more sensitive than toxins A and B EIAs making it an effective screening test for C. difficile infection. Although sensitive, GDH lacks specificity and so if this test was utilized, a confirmatory test to differentiate false positives from true positives was needed. Studies to date have used cytotoxin neutralization or toxigenic culture as confirmatory tests but both of these have their limitations. A testing algorithm using rapid immunochromatographic devices for detection of GDH and toxins A and B as screening tests will give an accurate test result in approximately 90% of specimens within one hour when using cytotoxin neutralization as a reference method. For the other 10% of specimens, a third test would be needed in the algorithm. This test could be cytotoxin neutralization, toxigenic culture, or PCR for toxin or toxin operon genes.

Effectiveness and safety of sofosbuvir-based regimens for chronic HCV genotype 3 infection: results of the HCV-TARGET study

LP08 SAFETY AND EFFICACY OF SOFOSBUVIR-CONTAINING REGIMENS IN HEPATITIS C INFECTED PATIENTS WITH REDUCED RENAL FUNCTION: REAL-WORLD EXPERIENCE FROM HCV-TARGET V. Saxena, F.M. Koraishy, M. Sise, J.K. Lim, R.T. Chung, A. Liapakis, D.R. Nelson, M. Schmidt, M.W. Fried, N. Terrault, and HCV-TARGET. University of California San Francisco, San Francisco, Saint Louis University School of Medicine, St. Louis, Massachusetts General Hospital, Boston, Yale University School of Medicine, New Haven, University of Florida, Gainesville, University of North Carolina, Chapel Hill, United States E-mail: varun.saxena@ucsf.edu

Predictors of Unplanned Hospitalization in Patients Receiving Outpatient Parenteral Antimicrobial Therapy Across a Large Integrated Healthcare Network

BACKGROUND Sofosbuvir (SOF) is active against all hepatitis C virus (HCV) genotypes, and SOF-based therapies lead to high rates of sustained virologic response (SVR). However, genotype 3 (GT3) HCV remains a challenge with lower SVR rates reported, particularly in patients with cirrhosis. This study reports the effectiveness and safety of SOF-based therapy in patients with GT3 HCV treated in clinical practice. METHODS Hepatitis C Virus Therapeutic Registry and Research Network is an international, prospective observational study evaluating patients treated in usual clinical practice. Patients with GT3 HCV were analyzed to assess predictors of treatment response and adverse events using descriptive statistics and multivariable logistic regression. RESULTS Treatment outcomes were available for 197 patients treated with SOF and ribavirin (RBV), with or without peginterferon, including 54% with cirrhosis and 49% who failed prior therapy. Of 178 patients treated with SOF/RBV, 60% achieved SVR at 12 weeks (SVR12), compared with 84% of 19 patients treated with SOF/peginterferon/RBV. For patients treated with SOF/RBV, the SVR12 rate was 58% in treatment-naive patients with cirrhosis, and 42% in those with cirrhosis who failed prior therapy. In noncirrhotic patients, SVR12 rates were 89% in treatment-naive and 88% in treatment-experienced patients. After controlling for age and sex, absence of cirrhosis (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.78-14.74), albumin levels ≥3.2 g/dL (OR, 12.48; 95% CI, 3.86-40.33), and platelet count >10(5) cells/µL (OR, 7.44; 95% CI, 3.51-15.78) were associated with greater odds of SVR12 CONCLUSIONS:  SVR rates were acceptable in patients with GT3 HCV without cirrhosis; however, in those with cirrhosis, treatment with SOF/RBV was suboptimal, highlighting the need for new therapies for this population.

Antimicrobial Prescribing Rates Comparing On-Site Visits with Two Types of Virtual Care Visits Across a Large Integrated Healthcare System

Summary Patients discharged on outpatient parenteral antimicrobial therapy (OPAT) to skilled nursing facilities have an associated 46% (incident risk ratio = 1.46; 95% confidence interval = 1.04–2.06) greater risk of having an unplanned hospitalization within 90 days of discharge compared with patients receiving OPAT at home after adjusting for demographics, treatment duration, indication, antimicrobial class, comorbidities, and time at risk.

Decreasing Mortality Among Patients Hospitalized With Cirrhosis in the United States From 2002 Through 2010

Abstract Background In 2014, Carolinas Healthcare System (CHS) implemented virtual visits and Electronic visits (eVisits) as an alternative to on-site visits to provide novel and convenient ways for patients to access care for non-emergent conditions. With virtual visits, patients have a face-to-face consultation with a provider by logging onto any device equipped with a camera. eVisits offer a lower tech alternative that allow patients to email their health concerns through a series of health-related questions. Providers respond via email with recommendations. No face-to-face interaction is included with eVisits. This study aimed to compare prescribing rates across these care delivery options. Methods We identified 2,478 virtual visits, 269 eVisits and 655,329 on-site visits between Jan 2014 to Feb 2017 where there was any diagnosis of bronchitis, sinusitis, non-suppurative otitis media and upper respiratory infection. Antimicrobial prescribing rates were standardized to per 100 visits (reported as a %) for each indication. Prescribing rates are reported for each visit type and indication. Chi square tests were used to compare rates across the visit types. Results Across all visit types and indications, on-site visits had the highest rate of antimicrobial prescribing and eVisits the lowest (onsite: 55.0; virtual: 51.3; eVisit 33.8; P < 0.001). Sinusitis was the most frequent indication for which an antimicrobial was prescribed, with on-site visits (86.6%), virtual (72.9%) and eVisits(57.8%) showing significantly different rates (P < 0.001). For upper respiratory infections, where an antimicrobial is not indicated, 34.5% of on-site, 11.0% of virtual and 2.0% of eVisits received an antimicrobial prescription (P < 0.001). Conclusion The mechanism of care delivery significantly impacts whether or not an antimicrobial is prescribed for specific diagnoses where a prescription may not be indicated. eVisits had the lowest rates of inappropriate prescribing for URI while on-site care showed significantly higher antimicrobial prescriptions. Further investigation is needed into the underlying causes of prescribing rate variances and how these care delivery options may affect efforts to reduce inappropriate utilization of antimicrobials. Disclosures All authors: No reported disclosures.