Rachel Beckerman

The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe.

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease. There is uncertainty around the economic burden of NAFLD. We constructed a steady‐state prevalence model to quantify this burden in the United States and Europe. Five models were constructed to estimate the burden of NAFLD in the United States and four European countries. Models were built using a series of interlinked Markov chains, each representing age increments of the NAFLD and the general populations. Incidence and remission rates were calculated by calibrating against real‐world prevalence rates. The data were validated using a computerized disease model called DisMod II. NAFLD patients transitioned between nine health states (nonalcoholic fatty liver, nonalcoholic steatohepatitis [NASH], NASH‐fibrosis, NASH‐compensated cirrhosis, NASH‐decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, post‐liver transplant, and death). Transition probabilities were sourced from the literature and calibrated against real‐world data. Utilities were obtained from NAFLD patients using the Short Form‐6D. Costs were sourced from the literature and local fee schedules. In the United States, over 64 million people are projected to have NAFLD, with annual direct medical costs of about

Ledipasvir/sofosbuvir regimens for chronic hepatitis C infection: Insights from a work productivity economic model from the United States.

103 billion (

Treatment of patients waitlisted for liver transplant with all‐oral direct‐acting antivirals is a cost‐effective treatment strategy in the United States

1,613 per patient). In the Europe‐4 countries (Germany, France, Italy, and United Kingdom), there are ∼52 million people with NAFLD with an annual cost of about €35 billion (from €354 to €1,163 per patient). Costs are highest in patients aged 45‐65. The burden is significantly higher when societal costs are included. Conclusion: The analysis quantifies the enormity of the clinical and economic burdens of NAFLD, which will likely increase as the incidence of NAFLD continues to rise. (Hepatology 2016;64:1577‐1586)

In an era of highly effective treatment, hepatitis C screening of the United States general population should be considered

Patients with chronic hepatitis C (CHC) exhibit reduced work productivity owing to their disease. Historically, most regimens indicated for CHC genotype 1 (GT1) patients were administered with pegylated interferon (Peg‐IFN) and/or ribavirin (RBV), which further compromised work productivity during treatment. The aim of this study was to model the impact of LDV/SOF (ledipasvir/sofosbuvir), the first Peg‐IFN‐ and RBV‐free regimen for CHC GT1 patients, on work productivity from an economic perspective, compared to receiving no treatment. The WPAI‐SHP (Work Productivity and Activity Index–Specific Health Problem) questionnaire was administered to patients across the ION clinical trials (N = 1,923 U.S. patients). Before initiation of treatment, patients with CHC GT1 in the ION trials exhibited absenteeism and presenteeism impairments of 2.57% and 7.58%, respectively. Patients with cirrhosis exhibited greater work productivity impairment than patients without cirrhosis. In total, 93.21% of U.S. patients in the ION trials achieved SVR; these patients exhibited absenteeism and presenteeism impairments of 2.62% (P = 0.76, when compared to baseline) and 3.53% (P < 0.0001), respectively. Monetizing these data to the entire U.S. population, our model projects an annual societal cost of

A decision-analytic model of idelalisib in relapsed or refractory patients with follicular lymphoma in the United States.

7.1 billion owing to productivity loss in untreated GT1 CHC patients. Our model projects that, when compared to no treatment, treating all CHC GT1 patients with a regimen with very high viral eradication rates (LDV/SOF) would translate to annual productivity loss savings of

A decision-analytic model of idelalisib in relapsed or refractory patients with indolent non-Hodgkin lymphoma.

2.7 billion over a 1‐year time horizon. Conclusions: Patients with untreated HCV impose a substantial societal burden owing to reduced work productivity. As a result of improvements in work productivity, treatment of CHC GT1 patients with LDV/SOF‐based regimens is likely to result in significant cost savings from a societal perspective, relative to no treatment. (Hepatology 2015;61:1471–1478)

A decision-analytic model of idelalisib and rituximab combination therapy versus rituximab monotherapy in relapsed, unfit chronic lymphocytic leukemia.

All‐oral direct acting antivirals (DAAs) have been shown to have high safety and efficacy in treating patients with hepatitis C virus (HCV) awaiting liver transplant (LT). However, there is limited empirical evidence comparing the health and economic outcomes associated with treating patients pre‐LT versus post‐LT. The objective of this study was to analyze the cost‐effectiveness of pre‐LT versus post‐LT treatment with an all‐oral DAA regimen among HCV patients with hepatocellular carcinoma (HCC) or decompensated cirrhosis (DCC). We constructed decision‐analytic Markov models of the natural disease progression of HCV in HCC patients and DCC patients waitlisted for LT. The model followed hypothetical cohorts of 1,000 patients with a mean age of 50 over a 30‐year time horizon from a third‐party US payer perspective and estimated their health and cost outcomes based on pre‐LT versus post‐LT treatment with an all‐oral DAA regimen. Transition probabilities and utilities were based on the literature and hepatologist consensus. Sustained virological response rates were sourced from ASTRAL‐4, SOLAR‐1, and SOLAR‐2. Costs were sourced from RedBook, Medicare fee schedules, and published literature. In the HCC analysis, the pre‐LT treatment strategy resulted in 11.48 per‐patient quality‐adjusted life years and

Equitable Access to All-Oral Direct-Acting Antiviral Therapy is a Mandatory Step to Achieve Global Hepatitis C Virus Eradication

365,948 per patient lifetime costs versus 10.39 and

Mo1169 Non-Alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes (DM): A Costly Combination

283,696, respectively, in the post‐LT arm. In the DCC analysis, the pre‐LT treatment strategy resulted in 9.27 per‐patient quality‐adjusted life years and

Mo1168 Reduction in Clinical and Economic Burden by Treating All Medicaid Patients With Chronic Hepatitis C (CHC): A Decision-Analytic Model

304,800 per patient lifetime costs versus 8.7 and