April 1, 2012

Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis C

Hepatology. 2012 Mar 27. doi: 10.1002/hep.25734. [Epub ahead of print]

Cammà C, Petta S, Enea M, Bruno R, Bronte F, Capursi V, Cicchetti A, Colombo GL, Di Marco V, Gasbarrini A, Craxì A; on behalf of the WEF Study Group..

Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy. calogero.camma@unipa.it.


Randomized controlled trials (RCTs) show that triple therapy (TT) with peginterferon alfa, ribavirin and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of previously untreated patients with genotype 1 (G1) chronic hepatitis C (CHC). We assess the cost-effectiveness of TT compared to DT in the treatment of untreated patients with G1 CHC.


We created a Markov Decision Model to evaluate, in an untreated Caucasian patients aged 50 years, weight 70 kg, with G1 CHC and Metavir F2 liver fibrosis score, for a time horizon of twenty years, the cost-effectiveness of the following 5 competing strategies: 1) Boceprevir response-guided therapyy (BOC-RGT); 2) Boceprevir IL28B genotype-guided strategy (BOC-IL28B); 3) Boceprevir rapid virologic response (RVR) guided strategy (BOC-RVR); 4) Telaprevir response-guided theapyy (TVR-RGT); 5) Telaprevir IL28B genotype-guided strategy (TVR-IL28B). Outcomes included life-years gained (LYG), costs (in 2011 euros), and incremental cost-effectiveness ratio (ICER).


In the base case analysis BOC-RVR and TVR-IL28B strategies were the most effective and cost-effective of evaluated strategies. LYG was 4.04 with BOC-RVR, and 4.42 with TVR-IL28B. ICER compared with DT was €8.304 per LYG for BOC-RVR, and €11.455 per LYG for TVR-IL28B. The model was highly sensitive to IL28B CC genotype, likelihood of RVR and of sustained virologic response, and BOC/TVR prices.


In untreated G1 CHC patients aged 50 years, TT with first generation protease inhibitors is cost-effective compared with DT. Multiple strategies to reduce costs and improve effectiveness include RVR or genotype-guided treatment. (HEPATOLOGY 2012.).


HIV Ups Lung Cancer Risk, Independent of Smoking

From Reuters Health Information

By Anne Harding

NEW YORK (Reuters Health) Mar 29 - HIV infection independently increases lung cancer risk by 70%, according to the largest study yet to examine the issue.

"After adjusting for smoking and traditional lung cancer risk factors, we do still find that there is some independent mechanism related to HIV that's increasing lung cancer risk in the HIV-infected population," Dr. Keith Sigel of the Mount Sinai School of Medicine in New York City, the study's first author, told Reuters Health.

People with HIV are known to be at increased risk of lung cancer, Dr. Sigel and his colleagues note in their study, published in AIDS online February 29. But it has not been clear, they add, whether this is because they are more likely to be smokers, or due to surveillance bias.

To investigate, the research team linked data from the Veterans Aging Cohort Study Virtual Cohort to the Veterans Affairs Central Registry.

From a total of 37,294 people with HIV and 75,750 non-infected individuals, 1,071 developed lung cancer. Lung cancer rates per 100,000 person-years were 204 in the HIV cohort and 119 in the control group.

After the researchers adjusted for smoking, age, sex, race, chronic obstructive pulmonary disease, and previous pneumonia, the incidence rate ratio for HIV and lung cancer was still significant, at 1.7.

There was no difference in stage at diagnosis between HIV patients and controls, suggesting that surveillance bias was not a factor in the higher rate of lung cancer in the HIV group.

HIV infection itself could boost lung cancer risk by suppressing the immune system, and also by causing chronic inflammation, Dr. Sigel noted in an interview.

"The impact of smoking raises risk 70%, so smoking is still the number-one area to target," he added. "It just highlights again that smoking cessation is such an important issue for patients with HIV. Also, I think this will lead to some interesting work into looking at the benefits of lung cancer screening in people with HIV."

It will be important to determine, he added, whether screening HIV-infected individuals for lung cancer has the same benefits as screening people without HIV, more benefit, or less benefit. Another key question that needs to be answered, he said, is whether lung cancer is more aggressive in people with HIV.

SOURCE: http://bit.ly/HtfHUf

AIDS 2012.


Savvy Senior: Recommended vaccinations for seniors


By: Jim Miller | Savvy Senior
Published: April 01, 2012 Updated: April 01, 2012 - 12:00 AM

Q: What types of vaccinations are recommended for seniors? I know about flu shots, but what else is recommended and what's covered by Medicare?

A: Most people think that vaccinations are just for kids, but adults, especially seniors, need their shots, too. Here's a breakdown of what vaccines the Centers for Disease Control and Prevention recommends for adults 50 and older, and how they're covered by Medicare.

Influenza (flu): You know seasonal flu shots are recommended to everyone 50 and older, but you may not know that seniors 65 and older have the option of getting a new high-potency flu vaccine instead of a regular flu shot. This vaccine, known as the Fluzone High-Dose, creates a stronger immune response for better protection. All annual flu shots are covered under Medicare Part B.

Pneumococcal: Pneumonia causes more than 40,000 deaths in the United States each year, many of which could be prevented by the pneumococcal polysaccharide vaccine. Everyone 65 or older needs to get this one-time vaccination, as well as those younger than 65 who smoke or have chronic health conditions such as asthma, lung and heart disease, diabetes, or a weakened immune system. This vaccination is also covered under Medicare Part B.

Zoster (shingles): Recommended for everyone 60 and older, shingles is a painful, blistering skin rash that affects more than 1 million Americans each year. All Medicare Part D prescription drug plans cover this one-time vaccination, but coverage amounts and reimbursement rules vary depending on where the shot is given. Be sure to check your plan. If you aren't covered, you can expect to pay $150 to $250.

Tdap (tetanus-diphtheria-pertussis): A one-time dose of the Tdap vaccine, which covers tetanus, diphtheria and pertussis (whooping cough), is recommended to all adults. If you have had a Tdap shot, you should return to getting a tetanus-diphtheria (Td) booster shot every 10 years. Most private health and Medicare Part D plans cover these vaccinations, but if you have to pay, they cost $20 to $100.

MMR (measles, mumps and rubella): Anyone born in 1957 or later who is unsure about their immunization history should receive the MMR shot. A blood test can tell whether someone has had any of these diseases or has received the MMR vaccine, but a test costs about $100. If you're unsure about your immunity, getting a booster shot is more cost-effective (about $50 and is usually covered by insurance) and isn't harmful, even if you're immune.

Hepatitis A: This is a two-dose series of shots recommended to adults 50 and older who have chronic liver disease, a clotting-factor disorder, have same-sex male partners, illicit injectable drug use, or who have close contact with a hepatitis A-infected individual or who travel to areas with a high incidence of hepatitis A. These shots are $60 to $300, but are covered by most health and Medicare prescription drug plans.

Hepatitis B: This three-dose series is recommended to adults 50 and older who are on dialysis, have renal disease or liver disease, are sexually active with more than one partner, have a sexually transmitted disease or HIV. These vaccinations are covered under Medicare Part B.

Meningitis: Adults 55 and younger who have never been vaccinated, have had their spleen removed, have certain blood deficiencies or plan to travel to parts of the world where meningitis is common should receive the meningococcal conjugate vaccine. Adults 56 and older should receive the polysaccharide vaccine. Covered by most health and Medicare Part D plans, this shot will cost $100 to $150 if you have to pay out-of-pocket.

To help you get a handle on which vaccines are appropriate for you, take the CDC "What Vaccines Do You Need?" quiz at www2.cdc.gov/nip/adultimmsched.

Also, talk to your doctor during your next visit about what vaccinations you should get.


Hepatitis C virus-specific cellular immune responses in individuals with no evidence of infection

Published on: 2012-03-28

The detection of hepatitis C virus (HCV)-specific T cell responses in HCV-uninfected, presumably unexposed, subjects could be due to an underestimation of the frequency of spontaneously resolving infections, as most acute HCV infections are clinically silent. To address this hypothesis, HCV-specific cellular immune responses were characterized, in individuals negative for an HCV PCR assay and humoral response, with (n=32) or without (n=33) risk of exposure to HCV.

Uninfected volunteers (n=20) with a chronically HCV-infected partner were included as positive controls for potential exposure to HCV and HCV infection, respectively. HCV-specific T cell responses in freshly isolated peripheral blood mononuclear cells were studied ex vivo by ELISPOT and CFSE-based proliferation assays using panels of HCV Core and NS3-derived peptides.

A pool of unrelated peptides was used as a negative control, and a peptide mix of human cytomegalovirus, Epstein-Bar virus and Influenza virus as a positive control. Overall, 20% of presumably HCV-uninfected subject tested had detectable T-cell responses to the virus, a rate much higher than previous estimates of HCV prevalence in developed countries.

This result would be consistent with unapparent primary HCV infections that either cleared spontaneously or remained undetected by conventional serological assays.

Author: Yves RiviereThomas MontangeGenevieve JanvierCaroline MarnataLudovic DurrieuMarie-Laure ChaixMaria IsaguliantsOdile LaunayJean-Louis BressonStanislas Pol

Credits/Source: Virology Journal 2012, 9:76

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