Comparative treatment effectiveness of direct acting antiviral regimens for hepatitis C: Data from the Veterans administration.

BACKGROUND AND AIMS: Data addressing real world effectiveness of direct acting antiviral agents in hepatitis C infected patients are now emerging. This study compared the sustained virologic response rates achieved 12 weeks post-treatment in patients treated with three such agents by the Veterans Health Administration. METHODS: A retrospective cohort study was conducted using patients who terminated treatment by July 1, 2015. Data were retrieved from the Veterans Health Administration electronic medical records system. Patients were included if sufficient viral load laboratory data were available to determine sustained virologic response. Applying an intention to treat approach and logistic regression analysis, the sustained virologic response rates achieved were compared across drug regimens. RESULTS: A total of 11 464 patients met study selection criteria. Without controlling for other risk factors, sustained virologic response at least 12 weeks post treatment was achieved in 92% of ledipasvir/ sofosbuvir, 86% of ombitasvir/paritaprevir/ritonavir/dasabuvir, and 83% of simeprevir/sofosbuvir patients. After adjusting for patient characteristics, simeprevir/sofosbuvir (93.3%) and ledipasvir/sofosbuvir (96.2%) patients were statistically more likely than ombitasvir/paritaprevir/ritonavir/dasabuvir (91.8%) patients to demonstrate sustained virologic response. Human immunodeficiency virus, hepatitis B infection, diabetes, obesity, previous treatment history and augmentation therapy using ribavirin did not impact sustained virologic response rates. Sustained virologic response rates were lower for patients under age 65, with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, indications of fibrosis, or a non-genotype 1 infection. Women and Caucasian patients were more likely to achieve a sustained virologic response. CONCLUSIONS: All three direct acting antiviral regimens appear highly effective in achieving sustained virologic response.

Estimated Human and Economic Burden of Four Major Adult Vaccine-Preventable Diseases in the United States, 2013.

Low uptake of routinely recommended adult immunizations is a public health concern. Using data from the peer-reviewed literature, government disease-surveillance programs, and the US Census, we developed a customizable model to estimate human and economic burden caused by four major adult vaccine-preventable diseases (VPD) in 2013 in the United States, and for each US state individually. To estimate the number of cases for each adult VPD for a given population, we multiplied age-specific incidence rates obtained from the literature by age-specific 2013 Census population data. We then multiplied the estimated number of cases for a given population by age-specific, estimated medical and indirect (non-medical) costs per case. Adult VPDs examined were: (1) influenza, (2) pneumococcal disease (both invasive disease and pneumonia), (3) herpes zoster (shingles), and (4) pertussis (whooping cough). Sensitivity analyses simulated the impact of various epidemiological scenarios on the total estimated economic burden. Estimated US annual cost for the four adult VPDs was $26.5 billion (B) among adults aged 50 years and older, $15.3B (58 %) of which was attributable to those 65 and older. Among adults 50 and older, influenza, pneumococcal disease, herpes zoster, and pertussis made up $16.0B (60 %), $5.1B (19 %), $5.0B (19 %), and $0.4B (2 %) of the cost, respectively. Among those 65 and older, they made up $8.3B (54 %), $3.8B (25 %), $3.0B (20 %), and 0.2B (1 %) of the cost, respectively. Most (80-85 %) pneumococcal costs stemmed from nonbacteremic pneumococcal pneumonia (NPP). Cost attributable to adult VPD in the United States is substantial. Broadening adult immunization efforts beyond influenza only may help reduce the economic burden of adult VPD, and a pneumococcal vaccination effort, primarily focused on reducing NPP, may constitute a logical starting place. Sensitivity analyses revealed that a pandemic influenza season or change in size of the US elderly population could increase these costs dramatically.

Comparison of health services use associated with ziprasidone and olanzapine among schizophrenia and bipolar disorder patients in the USA.

BACKGROUND AND OBJECTIVES: Ziprasidone is increasingly used for the treatment of schizophrenia and bipolar disorder. The purpose of this study was to compare healthcare costs and use associated with ziprasidone and olanzapine. METHODS: Ziprasidone and olanzapine treatment episodes of schizophrenia and bipolar disorder patients were identified in the 01/2007-12/2010 IMS LifeLink™ Database. The period of analysis for each episode has three components: 6 months prior to the episode initiation date (pre-episode period), 1 month immediately following the episode initiation date (initiation month), and up to 12 months after the end of the initiation month (follow-up period). Ordinary least squares regressions, general linear models, and two-part models were used to compare various types of costs (2007 US$) associated with the use of ziprasidone and olanzapine. Logistic regressions, Poisson regressions, and Hurdle models were used to compare the number of emergency department (ED) visits and hospitalizations associated with each drug. RESULTS: We identified 7,138 (46.93 %) ziprasidone episodes and 8,072 (53.07 %) olanzapine episodes, and found that patients using ziprasidone were significantly younger (41.50 vs. 45.38 years) and were significantly less likely to be male (29.81 vs. 44.21 %). Regression analysis showed no significant differences in total costs between the two drugs. However, ziprasidone was associated with significantly higher medication costs (US$232, p < 0.01) and outpatient costs (US$501, p < 0.05), yet lower ED costs (-US$73, p < 0.05). Ziprasidone was also associated with fewer ED visits (0.266, p < 0.001) and hospitalizations (1.117, p < 0.001). CONCLUSIONS: Ziprasidone is associated with higher medication costs and outpatient costs than olanzapine; however, it reduces patients' use of ED and inpatient services.