Cost-effective Hepatitis C Cure | News | Loyola Medicine
Wednesday, March 23, 2016

Loyola Researchers Foresee More Cost-effective Hepatitis C Cure

MAYWOOD, IL – The cost of treating hepatitis C virus (HCV) could be cut up to 50 percent if mathematical models are used to predict when patients can safely stop taking direct-acting antiviral (DAA) medication, according to a new study by researchers at Loyola University Health System and Loyola University Chicago.
 
An estimated 170 million people have the blood-borne infection worldwide, which is a major cause of chronic liver disease. The recent approval of DAAs has led to a revolution in the treatment of HCV, but the high cost of DAAs limits access to treatment in America and abroad.
 
“Recent clinical trials of DAAs against HCV suggest that cure of the infection often took place before the end of treatment,” said Harel Dahari, PhD, assistant professor at Loyola University Chicago Stritch School of Medicine.
 
“Treatment currently is standardized to be given for a set period of time, not tailored to the patient,” said Scott Cotler, MD, FCO, hepatology division division director for Loyola and Stritch professor. “In many cases, this may result in the prolonged use of expensive drugs with essentially no additional positive effect.”
 
Using more frequent blood testing to determine HCV levels, Loyola researchers were able to identify when a cure was reached and predict when therapy could be discontinued. This modeling could allow for individualized treatment to achieve optimal results while reducing drug duration and cost.
 
“This is the first time this approach has been tested in hepatitis C patients undergoing DAA treatment,” Dr. Dahari said. “This initial study is very encouraging.”
 
The lead authors, Drs. Dahari, Laetitia Canini, PhD, Susan L. Uprichard, PhD, and colleagues examined the test results of 58 chronic-HCV patients being treated with the widely used DAA drug sofosbuvir, combined with daclatasvir, simeprevir or ledipasvir, in three French referral centers. HCV was measured before treatment (called baseline), at day two, every other week, end of treatment and then 12 weeks after end of treatment. Mathematical modeling was used to predict the duration of treatment need to achieve a cure.
 
“The use of early viral-kinetic analysis has the potential to individualize duration of DAA therapy with a projected cost savings of 16 to 20 percent per 100 treated persons and up to 50 percent in about 40 percent of patients,” Dr. Dahari and colleagues wrote. “Shorter regimens with low pill burdens, and few adverse effects, could improve patient adherence in difficult to treat populations.”
 
The study, published in the Journal of Hepatology, is titled “HCV kinetic and modeling analyses indicate similar time to cure among sofosbuvir combination regimens with declatasvir, simeprevir or ledipasvir.”
 
Other authors of the study include collaborators from Germany (Frederik Graw), Brazil (Evaldo S.A. Araújo), and France (Guillaume Penaranda, Emilie Coquet, Laurent Chiche, Aurelie Riso, Christophe Renou, Marc Bourliere, and Philippe Halfon – as senior author).
 
The U.S. Centers for Disease Control (CDC) recommends that Baby Boomers (born 1945-1965), be tested for HCV. For undetermined reasons, people born during this era are five times more likely to be infected than other adults. The CDC reports that a one-time test of every Baby Boomer would find 800,000 new cases and prevent 120,000 deaths.
 
Loyola’s researchers and board-certified hepatologists, or liver disease experts, have developed effective, nationally recognized treatment plans for hard-to-treat and advanced cases of hepatitis B, hepatitis C and hepatocellular carcinoma. Additionally, the team is skilled in treating all aspects of liver disease, including cirrhosis and acute liver failure. Loyola has a highly successful liver transplant program. 

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.