Ponni V. Perumalswami

Costs of telaprevir-based triple therapy for hepatitis C:

In registration trials, triple therapy with telaprevir (TVR), pegylated interferon (Peg‐IFN), and ribavirin (RBV) achieved sustained virological response (SVR) rates between 64% and 75%, but the clinical effectiveness and economic burdens of this treatment in real‐world practice remain to be determined. Records of 147 patients who initiated TVR‐based triple therapy at the Mount Sinai Medical Center (May‐December 2011) were reviewed. Direct medical costs for pretreatment, on‐treatment, and posttreatment care were calculated using data from Medicare reimbursement databases, RED Book, and the Healthcare Cost and Utilization Project database. Costs are presented in 2012 U.S. dollars. SVR (undetectable hepatitis C virus [HCV] RNA 24 weeks after the end of treatment) was determined on an intention‐to‐treat basis. Cost per SVR was calculated by dividing the median cost by the SVR rate. Median age of the 147 patients was 56 years (interquartile range [IQR] = 51‐61), 68% were male, 19% were black, 11% had human immunodeficiency virus/HCV coinfection, 36% had advanced fibrosis/cirrhosis (FIB‐4 scores ≥3.25), and 44% achieved an SVR. The total cost of care was

189,000 per sustained virological response.

11.56 million. Median cost of care was

Hepatitis Outreach Network: A practical strategy for hepatitis screening with linkage to care in foreign-born communities

83,721 per patient (IQR = 

Virological response rates for telaprevir-based hepatitis C triple therapy in patients with and without HIV coinfection

66,652‐

Pregnancy-Related Liver Diseases

98,102). The median cost per SVR was

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus.

189,338 (IQR = 

Vaccination as a triggering event for autoimmune hepatitis.

150,735‐

Effect of fibrosis on adverse events in patients with hepatitis C treated with telaprevir

221,860). Total costs were TVR (61%), IFN (24%), RBV (4%), adverse event management (8%), professional fees (2%), and laboratory tests (1%). Conclusions: TVR and Peg‐IFN accounted for 85% of costs. Pharmaceutical prices and the low (44%) SVR rate, in this real‐world study, were major contributors to the high cost per SVR. (Hepatology 2014;60:1187–1195)

The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists

BACKGROUND & AIMS Many foreign-born persons in the US are at high risk of chronic hepatitis B (HBV) and C (HCV) infections, yet are not aware of their infection, and lack healthcare coverage or linkage to care. METHODS A unique partnership, the Hepatitis Outreach Network, combines the expertise and resources of the Mount Sinai School of Medicine, the NYC Department of Health and Mental Hygiene, and community-based organizations, to provide education, screening and link to care in communities with high prevalence of chronic viral hepatitis. Comprehensive HBV and HCV screening identifies infected patients, who then receive further evaluation from either local or Mount Sinai physicians, combined with patient-navigators who organize follow-up visits. RESULTS Of 1603 persons screened, 76 had HBV and 75 had HCV. Importantly, screening for HCV based on traditional risk factors would have missed 67% of those who tested positive. Of the 76 persons with HCV infection, 49 (64%) received a medical evaluation (26 with local providers and 23 at Mount Sinai). Of the 49 HCV-infected persons evaluated, treatment was recommended in 11 and begun in 8 (73%). Of the 76 persons with HBV infection, 43 (57%) received a medical evaluation (31 with local providers and 12 at Mount Sinai). Of the 43 HBV-infected persons evaluated, treatment was recommended and begun in 5 (100%). CONCLUSIONS Hepatitis Outreach Network has successfully established novel proof of concept for identifying HBV and HCV infections in foreign-born persons through use of several unique elements that effectively link them to care.

Is screening baby boomers for HCV enough? A call to screen for hepatitis C virus in persons from countries of high endemicity.

Pegylated‐interferon/ribavirin dual therapy for hepatitis C virus (HCV) infection has a lower sustained virological response (SVR) rate in HIV/HCV‐coinfected patients than in HCV monoinfected patients, but little is known about the relative effectiveness of teleprevir‐based triple therapy in the two groups.