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THE BURDEN OF HEPATITIS C IN EUROPE-PATIENT'S PERSPECTIVE

2/21/2013

1 Comment

 
 BMC Gastroenterology Jan 17 2013
  Jeffrey Vietri, Girish Prajapati and
Antoine Khoury

"Conclusions: The humanistic and economic burden of HCV
in Europe is  substantial. The pattern of results is similar among
treatment-naïve  patients, which suggests that the burden of treatment is not
driving the  elevated resource use and lower HRQoL observed in the broader
sample.  Effective treatment of HCV may alleviate the work impairment associated
with  HCV and lower use of healthcare resources, while providing improved
quality  of life to the individual."

  Abstract (provisional)

Background


  Few studies have examined the impact of Hepatitis C
virus (HCV) infection on  patient reported outcomes in Europe. This study was
conducted to assess the  burden of HCV infection in terms of work productivity
loss, activity  impairment, health-related quality of life, healthcare resource
utilization,  and associated costs.

Methods

  The 2010
European National Health and Wellness Survey (n = 57,805) provided  data.
Patients reporting HCV infection in France, Germany, the UK, Italy, and  Spain
were matched to respondents without HCV using propensity scores.  Outcome
measures included the Work Productivity and Activity Impairment  (WPAI)
questionnaire and the Medical Outcomes Study Short Form-12 (SF-12v2) 
questionnaire. Subgroup analyses focused on treatment-naive
patients.

Results

  HCV Patients (n = 286) had more work
impairment (30% vs. 18%, p < .001),  more impairment in non-work activities
(34% vs. 28%, p < .05), and more  annual physician visits per patient (19.8
vs. 13.3, p < .001). Estimated  indirect and direct costs were [euro
sign]2,956 (p < .01) and [euro  sign]495 (p < .001) higher than in matched
controls, respectively.  Health-related quality of life was also lower among HCV
patients.  Treatment-naive HCV patients (n = 139) also reported higher work
impairment  (29% vs. 15%, p < .01), as well as more frequent physician visits
(19.5  vs. 12.1, p < .01) than matched controls. Each treatment-naive HCV 
infected patient incurred [euro sign]934 in direct costs vs. [euro sign]508  (p
< .01 in matched controls. Employed treatment-naive patients reported  higher
productivity loss per year compared to matched controls ([euro  sign]6,414 vs.
[euro sign]3,642, p < .05).

  Conclusion


  HCV infection in
Europe is associated with considerable economic and  humanistic burden. This is
also true of diagnosed patients who have never  been treated for
HCV.

DISCUSSION

  The present study included data from a
large survey of European adults with  and without HCV infection across five
counties, which measured outcomes  through widely used validated scales.
Patients reporting a physician  diagnosis of HCV infection had significantly
impaired work productivity,  greater impairment in non-work activities, more
healthcare resource  utilization, and worse HRQoL than both the general
population without HCV and  propensity-matched individuals without HCV
infection. The economic costs of  HCV infection are considerable. We estimated
work-productivity impairment due  to HCV costs over euro 7,500 per employed
patient per year, an incremental  indirect cost of almost

  euro 3,000
over matched controls. Direct costs are also elevated by almost  euro 500 per
patient when compared to matched controls. The intangible cost  of lower HRQoL
observed in this sample was also significant, particularly  regarding physical
quality of life and health utility. HCV patients had  consistently worse
outcomes than matched controls across almost all outcome  measures, though some
measures of healthcare resource use did not reach  significance. This seems to
be primarily an issue of statistical power, as  those that did not reach
significance-ER visits and hospitalizations-were  those measuring rare events
experienced by a minority of respondents. A  previous study using the same
measures but using a larger, US sample found  significant results, despite
observing numerically smaller differences  between HCV patients and controls
[24]. Otherwise, the HRQoL decrements and  work impairment observed in the
present analysis are consistent with those  measured in the US NHWS, and of a
similar magnitude [18].

  In addition to examining HCV infected patients
as a whole, the present study  also considered treatment-naïve patients
separately. The treatment-naïve  patients are an especially interesting
subgroup, as they are neither burdened  by the adverse events of treatment, nor
benefited from a successful therapy,  and so may better represent the burden of
untreated HCV infection. Relative  to matched controls, these patients reported
greater impairment at work and  more frequent physician visits, and estimated
costs were also higher. Unlike  treatment-experienced patients, these
individuals' elevated resource use  would not be due to treatment or adverse
events associated with such  treatment, nor would work impairments or reduced
HRQoL be due to side  effects. The pattern of results in this subgroup was
generally consistent  with the findings in the broader comparisons, with few
exceptions.  Treatment-naïve patients did not show significantly elevated
absenteeism  relative to matched controls, but the magnitude of the difference
was actually  larger than in the broader comparison, suggesting that this
difference is  simply due to a lack of power rather than a different pattern
among  treatment-naïve patients.

  The use of propensity scoring matching
ensures that none of the effects  observed could be attributed to any
demographic or health history variables  included in the matching analyses.
However, we cannot rule out the  possibility that additional variables (such as
prior drug use) not included  in the matching may explain the observed
differences in health outcomes.  However, most of the likely factors (co-morbid
health conditions, health  behaviors, etc.) were equated by the matching
procedure.

  The self-report survey methodology did not allow us to
verify HCV diagnosis.  However, the findings coincide with those of previous
studies, suggesting  this HCV sample is similar to that of other,
clinically-verified HCV samples.  We were also unable to confirm that controls
were free of HCV infection, and  given that many HCV patients are unaware of the
infection it is possible that  HCV patients were in the control group, causing
us to underestimate the  impact of HCV infection. The current study did not
assess reasons for  healthcare resource utilization but, given the propensity
score methodology,  the assumption was made that the additional resources used
by the HCV group  were due to the virus itself, as none of the assessed
demographic or non-HCV  health history variables differed between the groups.
Some selection bias may  also be present, in that individuals who completed the
survey may have  differed in some meaningful way from those who did not respond.
However, for  such a bias to affect the conclusions, the effect of HCV would
have to be  different among those who chose not to complete the survey than in
those who  did respond, which seems unlikely. Finally, the modest number of HCV
infected  respondents limits the precision of the estimates of the associated
burden,  though this would not contribute to spurious positive
findings.

Conclusions

  The humanistic and economic burden
of HCV in Europe is substantial. The  pattern of results is similar among
treatment-naïve patients, which suggests  that the burden of treatment is not
driving the elevated resource use and  lower HRQoL observed in the broader
sample. Effective treatment of HCV may  alleviate the work impairment associated
with HCV and lower use of healthcare  resources, while providing improved
quality of life to the individual.


 
1 Comment

Fried Foods Have Similar Impact On Your Liver as Hepatitis

2/17/2013

0 Comments

 

February 16, 2013
  (CBS News) There are 160,000
fast food restaurants in the United States, serving over 50 million customers
daily and the bulk of the food offerings are loaded with calories from fat and
added sugar.
"We're all guilty, and every now and then you have to splurge,
but the problem is that so many people are getting into eating fast food,
especially kids, as their staple, and I think that's the point," said Dr. Drew
Ordon of "The Doctors" and author of the book, "Better in 7."
Subway sorry its "Footlong" sandwich didn't cut mustard
"The Doctors" revealed study
found regular consumption of fast food items like fried chicken and onion rings
are particularly bad for your liver, and these fried foods have many surprising
complications and dangers for the people that consume them.
"The amount of
fat and saturated fats creates a condition called fatty liver," said
Ordon.
What's interesting about the new information is that even after just a
month of consistently eating fatty foods from fast food restaurants, there are
significant changes in your liver. The fried foods do not just impact your
cholesterol and waist line.Ordon describes the changes in the liver enzymes as
 being surprisingly similar to the damage that is seen by hepatitis, which can
ultimately lead to liver failure.
Burger King drops supplier linked to horsemeat
They found that french fries, in particular, are one of the most
dangerous foods, because of all the added ingredients to the potato.
"We know
that they are adding salt, and cooking it in fat, but they're also putting sugar
on them too. Why sugar? Because it helps get them golden crispy," advised Ordon.
"It's three strikes."
He also warns that consumers should be wary of items at
fast food establishments marked healthy or freshbecause there aren't clear regulations for these items, and the food can often
have added chemicals, especially salads.
"Some places actually put propylene
glycol on the salads, which is anti-freeze, the reason behind that is that it
prevents wilting," said Ordon. "And although they say a little anti-freeze isn't
going to hurt you, obviously given a choice you don't want to be eating
anti-freeze
0 Comments

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