Scenarios to manage the hepatitis C disease burden and associated economic impact of treatment in Turkey.

BACKGROUND: Hepatitis C virus (HCV) infection is a significant health problem. The aim of this study is to evaluate the cost-effectiveness of HCV treatment and estimate its economic burden in Turkey. METHODS: An Excel-based disease progression model was used to estimate the HCV-infected population for 2015-2030. Direct costs in US dollars (USD) including diagnostic, laboratory, and healthcare costs were provided by experts in the country. Indirect costs were estimated as lost productivity using the World Health Organization (WHO) disability-adjusted life years (DALYs) metric from the Global Burden of Disease study. Three scenarios were developed to estimate the cost-effectiveness of HCV treatment through 2030: Base 2016, Increase Treatment and SVR (where SVR is sustained virological response), and WHO Targets. Additionally, the WHO Targets scenario was assessed at three different treatment price points: 10,900 USD, 16,730 USD (base cost), and 27,285 USD. RESULTS: Cumulative total direct and indirect costs (2015-2030) for the WHO Targets scenario were estimated to be 10.8 billion USD, or a 1.5 % increase compared with Base 2016. However, by the following decade, due to a marked decline in DALYs, cumulative direct and indirect costs were estimated to be 45 % less when compared with Base 2016. At a threshold of 9125 USD, all scenarios were cost-effective. CONCLUSIONS: By implementing the WHO Targets scenario, Turkey would be able to lower HCV prevalence by 80 % and reduce the total number of liver-related deaths by >65 % by 2030. Treating HCV infection in the country is cost-effective if healthcare and indirect costs are taken into consideration.

A Quasi-Experimental Study Analyzing the Effectiveness of Portable High-Efficiency Particulate Absorption Filters in Preventing Infections in Hematology Patients during Construction.

OBJECTIVE: The increased risk of infection for patients caused by construction and renovation near hematology inpatient clinics is a major concern. The use of high-efficiency particulate absorption (HEPA) filters can reduce the risk of infection. However, there is no standard protocol indicating the use of HEPA filters for patients with hematological malignancies, except for those who have undergone allogeneic hematopoietic stem cell transplantation. This quasi-experimental study was designed to measure the efficacy of HEPA filters in preventing infections during construction. MATERIALS AND METHODS: Portable HEPA filters were placed in the rooms of patients undergoing treatment for hematological malignancies because of large-scale construction taking place near the hematology clinic. The rates of infection during the 6 months before and after the installation of the portable HEPA filters were compared. A total of 413 patients were treated during this 1-year period. RESULTS: There were no significant differences in the antifungal prophylaxis and treatment regimens between the groups. The rates of infections, clinically documented infections, and invasive fungal infections decreased in all of the patients following the installation of the HEPA filters. When analyzed separately, the rates of invasive fungal infections were similar before and after the installation of HEPA filters in patients who had no neutropenia or long neutropenia duration. HEPA filters were significantly protective against infection when installed in the rooms of patients with acute lymphocytic leukemia, patients who were undergoing consolidation treatment, and patients who were neutropenic for 1-14 days. CONCLUSION: Despite the advent of construction and the summer season, during which environmental Aspergillus contamination is more prevalent, no patient or patient subgroup experienced an increase in fungal infections following the installation of HEPA filters. The protective effect of HEPA filters against infection was more pronounced in patients with acute lymphocytic leukemia, patients undergoing consolidation therapy, and patients with moderate neutropenia.

Tenofovir-best hope for treatment of chronic hepatitis B infection?

BACKGROUND/AIMS: To evaluate the effectiveness of tenofovir in patients with chronic hepatitis B infection in a real life setting. MATERIALS AND METHODS: We performed a retrospective analysis of data from 164 patients with chronic hepatitis B who were treated with Tenofovir. Eighty-six patients (52.4%) were naïve. Seventy-seven (46.9%) patients were previously treated with anti-viral drugs, including standard interferon (n=4), pegylated (PEG) interferon (n=14), standard interferon together with lamivudine (n=13), lamivudine alone (n=41), adefovir (n=2), lamivudine together with adefovir (n=1), and entecavir (n=2). Six patients (3.7%) had liver cirrhosis before treatment of tenofovir. RESULTS: The patients who have hepatitis B viral DNA>104 copy/mL with chronic hepatitis B infection were included in the treatment of Tenofovir. Average follow up time was 30.31±14.33 months. HBV DNA negativity and alanine aminotransferase (ALT) normalization were 86.5% and 71.3%, respectively, at the last visit. Hepatitis B e-Antigen (HBeAg) seroconversion occurred in 11 (19.6%) out of 164 patients. During the follow-up period, 4 (2.4%) patients developed liver cirrhosis and in 5 (3%) patients hepatocellular carcinoma (HCC) occurred out of 164 patients. HBsAg seroconversion occurred in one patient (0.6%). CONCLUSION: Tenofovir can be used safely and successfully in those patients that were naive, experienced with immune modulators and/or antivirals, HBeAg-positive, and HBeAg-negative patients.

The characteristics of patients with chronic hepatitis B in Turkey.

AIM: To evaluate the characteristics of patients with hepatitis B virus (HBV) infection and summarize the treatment modalities. METHODS: By September 30, 2011 the data of 7871 HBsAg (+) patients were complied and analysed according to demographic and medical records (age, sex, laboratory tests, treatment with antiviral agents) in thirty centres of Turkey. RESULTS: Of the 7871 patients 3078 (39.1%) were females; mean (standard deviation) age was 35 (14) years, 3180 (40.4%) were HBsAg positive (+) after admission to a hospital, 1488 (18.9%) after blood donation and 967 (11.9%) were found during routine screening. The HBV prevalence among relatives of HBsAg (+) patients was 1764 (22.4%), and most frequently infected family members were siblings and mothers, 4961 (63.0%) and 2149 (27.3%), respectively). Anti-HDV was negative in 7407 94.1% of patients. Three-fourths of the patients 6383 (81.1%) were HBeAg negative (-). Mean (SD) ALT was 85.8 (266.4) U/L. Majority of patients, 5588 (71.0%) were chronic hepatitis-B patients under treatment, while 2283 (29.0%) were asymptomatic carriers without treatment and only 165 (2.1%) of patients were cirrhotic and 6612 (84.0%) of those were compensated. One-third of the patients 2983 (37.9%) were under a combined treatment, while others were under monotherapy. Lamivudine, entecavir and adefovir were the most frequently used oral therapies, used for 2583 (32.8%), 11.6% and 787 (10.0%) of patients, respectively), while 2975 (37.8%) of patients were under interferon treatment. CONCLUSION: Hepatitis B is still a problem in our country. First task of the physicians and our state should be to prevent the development and spread of the disease with education and vaccination programs, safe blood transfusions, and control of barbers.

Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study.

OBJECTIVE: We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. METHODS: A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. RESULTS: Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). CONCLUSION: ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.

Pegylated interferon alfa-2B for chronic delta hepatitis: 12 versus 24 months.

BACKGROUND/AIMS: The aim of this study was to evaluate the efficacy of pegylated interferon (PEG-IFN) alfa-2b for short (one year) and long (two years) terms of treatment for chronic hepatitis D. METHODOLOGY: Eighteen patients with chronic hepatitis D were administered PEG-IFN alfa-2b 1.5µg/kg twice weekly for 1 month, after which they were randomly assigned (2:1) to receive PEG-IFN alfa-2b 1.5µg/kg/wk for an additional 23 months (n=11; group 1) or 11 months (n=7; group 2). All patients were followed-up for 6 months after completing therapy. RESULTS: In group 1, there was no significant difference between HDV-RNA and ALT levels at follow-up compared with baseline (p=0.219 and p=0.624, respectively). However, in group 2, HDVRNA levels, but not ALT levels, were significantly lower at the end of follow-up (EOF) than at baseline (p=0.016 and p=0.237, respectively). Three patients, all in group 2, had undetectable hepatitis B surface antigen (HBsAg) at the end of followup (EOF). However, there was no patient who had undetectable HBsAg in group I (p=0.043). There were statistical differences for all 18 patients in terms of baseline levels of HDV-RNA compared to end of treatment (EOT) (p=0.021) and EOF (p=0.003). CONCLUSIONS: Extending therapy from 12 to 24 months conferred no additional advantage in terms of HDV-RNA suppression and ALT normalisation.

The impact of a nationwide antibiotic restriction program on antibiotic usage and resistance against nosocomial pathogens in Turkey.

PURPOSE: Antimicrobial resistance among microorganisms is a global concern. In 2003, a nationwide antibiotic restriction program (NARP) was released in Turkey. In this study we evaluated the effect of NARP on antibiotic consumption, antimicrobial resistance, and cost. MATERIALS AND METHODS: The data obtained from all of the four university hospitals, and one referral tertiary-care educational state hospital in Ankara. Antimicrobial resistance profiles of 14,233 selected microorganisms all grown in blood cultures and antibiotic consumption from 2001 to 2005 were analyzed retrospectively. RESULTS: A negative correlation was observed between the ceftriaxone consumption and the prevalence of ceftriaxone resistant E.coli and Klebsiella spp. (rho:-0.395, p:0.332 and rho:-0.627, p:0.037, respectively). The decreased usage of carbapenems was correlated with decreased carbapenems-resistant Pseudomonas spp. and Acinetobacter spp (rho:0.155, p:0.712 and rho:0.180, p:0.668, respectively for imipenem). Methicillin resistance rates of S.aureus were decreased from 44% to 41%. After two years of NARP 5,389,155.82 USD saving occurred. CONCLUSION: NARP is effective in lowering the costs and antibiotic resistance.

[Prevalence of extrahepatic illnesses in patients with chronic hepatitis b and hepatitis c: retrospective study of 435 patients]. / Kronik hepatit B ve hepatit C saptanan hastalarda ekstrahepatik hastaliklarin sikligi: 435 hastanin retrospektif olarak incelenmesi.

Chronic infections that caused by hepatitis B and C viruses, are important all of the world as a public health problem. Despite intensive control measurements, the incidences of chronic hepatitis B and C virus infections in our country are estimated as 5-7% and 3%, respectively. There are accumulating data of especially autoimmune mediated extrahepatic manifestations of hepatitis B and C virus infections, such as Diabetes Mellitus (DM), Behçet's Disease (BD), hypo- or hyper-thyroiditis and autoimmune diseases. The aim of this study was the retrospective evaluation of 400 chronic B hepatitis (CBH) and 35 C hepatitis (CCH) patients by means of the presence of extrahepatic manifestations. As a result, the positivity rates of extrahepatic manifestations detected in CBH and CCH patients were as follows respectively; 1.5% and 8.5% for DM, 1.5% and 5.7% for hypothyroiditis, 0.75% and 2.8% for hyperthyroiditis, 2% and 20% for nodular goitre, 0.25% and 5.7% for BD, 1% and 0% for systemic lupus, 1% and 5.7% for Rheumatoid Arthritis (RA), and 22% and 11.4% for iron deficiency anemia. DM, thyroid diseases and RA were the most common extrahepatic manifestations detected in both of the patient groups, while the rates of DM, BD and nodular goitre were found higher in CCH patients than CBH patients (p < 0.05). As a result, the extrahepatic manifestations should be carefully followed in patients with chronic hepatitis B and C infections, for an early diagnosis and appropriate treatment.

[Hepatitis A and hepatitis E seroprevalence in adults in the Ankara area]. / Ankara bölgesinde eriskinlerde hepatit a ve hepatit E seroprevalansi.

In this study, between the period of September 2000 to July 2001, hepatitis A virus (HAV) IgG antibodies and hepatitis E virus (HEV) total (IgG + IgM) antibodies have been searched by using commercially provided enzyme immunoassay kits (Axsym, Abbott USA), in 1046 adults aged between 15-75 years old (mean age: 32.3 years), who were admitted to the outpatient clinics of Internal Medicine and Infectious Diseases Department of Ankara University Medical School, with no acute hepatitis signs and symptoms. As a result, anti-HAV and anti-HEV seropositivities were detected in 914 (87.4%) and 40 (3.8%) subjects, respectively. The seropositivity rate for anti-HAV was 72.7% at the ages of 15-30 years, while anti-HEV was negative in this age group. Anti-HAV and anti-HEV seropositivity rates were found to be the highest between the ages of 30-60 years.