- Email: [email protected]
1114 RELEVANCE OF ACCURATE HEPATITIS C VIRUS GENOTYPING AND SUBTYPING IN THE CLINICAL PRACTICE
POSTERS to-treat with interferon, and 2) to explore shorter durations of therapy. Methods: Arm 6) Ten treatment-naïve non-cirrhotic patients with HCV GT2 or GT3 receive PSI-7977+ PEG/RBV ×8wk; 7). Ten prior “null” responders with HCV GT1 receive PSI-7977/RBV ×12w; 8) Twenty-five GT2/3 prior non-responders receive PSI-7977/RBV ×12w; 9) twenty-five treatment-naive non-cirrhotic patients with HCV GT1 receive PSI-7977/RBV ×12w. Results: Arm 6 enrolled 10 subjects with HCV GT3, with BL HCV RNA 6.1 log10 IU/mL; all 10 achieved HCV RNA
While in the two assays HCV-1 subtyping relies in genomic regions that are more variable than the 5 UTR, a subtype could not be assigned in 2/118 (1.69%) cases with the Versant assay and in 10/286 (3.50%) cases with the Abbott assay. Conclusions: Although in low proportions, commercial assays may fail at assign the genotype and the HCV-1 subtype. Thus, it is important that microbiology laboratories are able to implement reference techniques such as NS5B or Core sequencing and phylogenetic analysis to interpret those results. Reference techniques for HCV genotyping may also lead to the identification of previously uncharacterized subtypes, and to the improvement of commercial assays. 1115 IMPACT OF HCV TREATMENT AND DISEASE SEVERITY ON HEALTH CARE COSTS IN CHRONIC HCV PATIENTS: ANALYSIS OF A LARGE US PRIVATE HEALTH INSURANCE CLAIMS DATABASE S.C. Gordon1 , P.J. Pockros2 , N.A. Terrault3 , R.S. Hoop4 , A. Buikema5 , D. Nerenz1 , F.M. Hamzeh4 . 1 Henry Ford Health Systems, Detroit, MI, 2 Scripps Clinic and Scripps Translational Science Institute, La Jolla, 3 University of California, San Francisco, 4 Genentech, South San Francisco, CA, 5 OptumInsight, Eden Prairie, MN, USA E-mail: [email protected] Background and Aims: Recent data demonstrate that birth cohort screening for HCV antibody is cost-effective. Successful treatment of chronic hepatitis C is associated with a reduced incidence of liverrelated morbidity and mortality. However, the impact of treatment on follow-up health care costs has not been well documented. This study compared direct health care costs in treated versus nottreated patients by disease severity using data from a large US private insurance database. Methods: HCV patients with at least ≥2 years of baseline and ≥30 days of continuous follow-up between January 2001 and August 2010 were enrolled. Patients were stratified by liver disease severity: non-cirrhotic liver disease (NCD), compensated cirrhosis (CC), and end-stage liver disease (ESLD), defined by International Classification of Diseases (ICD-9) codes. Mean all-cause, follow-up direct health care costs per-patient-per-month (PPPM, 2010 US$) for treated and untreated patients were compared. Results: See Table 1. We found that: 1. 82% of US patients with health care insurance did not receive any antiviral HCV treatment; 2. subsequent all-cause health care costs were lower in treated patients compared with non-treated patients; and 3. all-cause health care costs were approximately 4-fold higher in HCV treated patients with ESLD compared with treated patients with NCD. Mean all-cause PPPM health-care costs in the follow-up period were 29% higher for non-treated patients compared to treated patients. PPPM costs were consistently higher for non-treated vs treated patients within each liver disease stratum. Conclusions: These data suggest that early HCV treatment may prevent progression of liver disease to CC and ESLD and thus significantly reduce follow-up health care costs. Table 1. Mean all-cause, follow-up health care costs
Male, % Mean age, years Mean follow-up PPPM health care costs, 2010 $US All patients NCD cohort CC cohort ESLD cohort
Journal of Hepatology 2012 vol. 56 | S389–S548
Treated (N = 4,116)
Not treated (N = 29,334)
p-value
63.9 49.6
61.2 50.3
0.001 <0.001
$1,509 (n = 4,116) $918 (n = 3,005) $1,400 (n = 262) $3,634 (n = 849)
$1,943 (n = 29,334) $1,375 (n = 23,094) $1,793 (n = 1,960) $5,077 (n = 4,280)
<0.001 <0.001 0.068 <0.001
S439
While in the two assays HCV-1 subtyping relies in genomic regions that are more variable than the 5 UTR, a subtype could not be assigned in 2/118 (1.69%) cases with the Versant assay and in 10/286 (3.50%) cases with the Abbott assay. Conclusions: Although in low proportions, commercial assays may fail at assign the genotype and the HCV-1 subtype. Thus, it is important that microbiology laboratories are able to implement reference techniques such as NS5B or Core sequencing and phylogenetic analysis to interpret those results. Reference techniques for HCV genotyping may also lead to the identification of previously uncharacterized subtypes, and to the improvement of commercial assays. 1115 IMPACT OF HCV TREATMENT AND DISEASE SEVERITY ON HEALTH CARE COSTS IN CHRONIC HCV PATIENTS: ANALYSIS OF A LARGE US PRIVATE HEALTH INSURANCE CLAIMS DATABASE S.C. Gordon1 , P.J. Pockros2 , N.A. Terrault3 , R.S. Hoop4 , A. Buikema5 , D. Nerenz1 , F.M. Hamzeh4 . 1 Henry Ford Health Systems, Detroit, MI, 2 Scripps Clinic and Scripps Translational Science Institute, La Jolla, 3 University of California, San Francisco, 4 Genentech, South San Francisco, CA, 5 OptumInsight, Eden Prairie, MN, USA E-mail: [email protected] Background and Aims: Recent data demonstrate that birth cohort screening for HCV antibody is cost-effective. Successful treatment of chronic hepatitis C is associated with a reduced incidence of liverrelated morbidity and mortality. However, the impact of treatment on follow-up health care costs has not been well documented. This study compared direct health care costs in treated versus nottreated patients by disease severity using data from a large US private insurance database. Methods: HCV patients with at least ≥2 years of baseline and ≥30 days of continuous follow-up between January 2001 and August 2010 were enrolled. Patients were stratified by liver disease severity: non-cirrhotic liver disease (NCD), compensated cirrhosis (CC), and end-stage liver disease (ESLD), defined by International Classification of Diseases (ICD-9) codes. Mean all-cause, follow-up direct health care costs per-patient-per-month (PPPM, 2010 US$) for treated and untreated patients were compared. Results: See Table 1. We found that: 1. 82% of US patients with health care insurance did not receive any antiviral HCV treatment; 2. subsequent all-cause health care costs were lower in treated patients compared with non-treated patients; and 3. all-cause health care costs were approximately 4-fold higher in HCV treated patients with ESLD compared with treated patients with NCD. Mean all-cause PPPM health-care costs in the follow-up period were 29% higher for non-treated patients compared to treated patients. PPPM costs were consistently higher for non-treated vs treated patients within each liver disease stratum. Conclusions: These data suggest that early HCV treatment may prevent progression of liver disease to CC and ESLD and thus significantly reduce follow-up health care costs. Table 1. Mean all-cause, follow-up health care costs
Male, % Mean age, years Mean follow-up PPPM health care costs, 2010 $US All patients NCD cohort CC cohort ESLD cohort
Journal of Hepatology 2012 vol. 56 | S389–S548
Treated (N = 4,116)
Not treated (N = 29,334)
p-value
63.9 49.6
61.2 50.3
0.001 <0.001
$1,509 (n = 4,116) $918 (n = 3,005) $1,400 (n = 262) $3,634 (n = 849)
$1,943 (n = 29,334) $1,375 (n = 23,094) $1,793 (n = 1,960) $5,077 (n = 4,280)
<0.001 <0.001 0.068 <0.001
S439