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|Issue 67||June 2013|
Assessment of Alternative Treatment Strategies for Chronic Genotype 1 Hepatitis C: A Systematic Review
Chronic genotype 1 (GT1) Hepatitis C (HCV) infections have been historically difficult to treat, with low cure rates on standard two-drug therapy (Pegylated Interferon + Ribavirin), high rates of side-effects and treatment discontinuation, and low rates of uptake. Recently, the FDA approved two directly acting antivirals (DAAs) -- boceprevir and telaprevir. Used in combination with standard two-drug therapy as triple therapy, these DAAs show higher rates of sustained viral response, though they also are more costly and have more severe side-effect profiles. Moreover, IL-28B patient genotyping can help identify patients least likely to respond to standard therapy, and who stand to benefit the most from triple therapy, and thus for whom the increased risks of side-effects may be most justified.
Investigators with the VA Evidence-based Synthesis Program, HSR&D's Health Economics Resource Center, and Stanford University addressed key questions about the use of triple therapy and genotyping by: 1) conducting an observational analysis of VA data to evaluate the uptake, use, and costs of therapies for HCV; 2) adapting previously developed HCV computer model to more closely reflect VA patient populations with chronic GT1 HCV infections and patterns of care; and 3) performing model-based projections of health outcomes and costs of alternative HCV treatment strategies. Investigators also reviewed the literature (PubMed) from 2000-2012 for information on chronic HCV infections in U.S. Veterans.
Based on simulation modeling analysis over five years depending on treatment uptake rates, universal triple therapy is likely to:
Key Question #3
Based on simulation modeling analysis over five years depending on treatment uptake rates, in comparing IL-28B guided triple therapy to standard two-drug therapy:
Based on simulation modeling analysis over five years depending on treatment uptake rates, replacement of standard two-drug therapy with triple therapy is likely to:
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers — and to disseminate these reports throughout VA.
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This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.
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