Liver-specific case fatality due to chronic hepatitis C virus infection: a systematic review.

Despite reports that mortality is increasing, overall case fatality due to hepatitis C virus (HCV) is thought to be low. Given the variability in published rates, we aimed to synthesize estimates of liver-specific case fatality and all-cause mortality in chronic HCV according to follow-up duration, sustained viral response (SVR) to treatment, and liver disease severity. A systematic review was conducted of studies published in English from 2003 to 2013, reporting liver-specific case fatality estimates from HCV-infected samples. Thirty-five eligible articles were identified; 26 also presented estimates of all-cause mortality. Among community-based samples, liver-specific case fatality ranged from 0.3% over 5.7 years to 9.2% over 8.2 years of follow-up; and of all-cause mortality, from 4.0% over 5.7 years, to 23.0% over 8.2 years of follow-up. Estimates were higher among clinic-based samples and those with more severe liver disease. Among treated patients achieving SVR, liver-specific case fatality was low: up to 1.4% over 11.5 years of follow-up among samples with any severity of liver disease. Estimates were higher among those without SVR: up to 14.0% over 10 years of followup among samples with any severity of liver disease, and higher still among samples with more severe liver disease. The proportion of deaths attributable to liver-specific causes ranged from 55 to 85% among those with severe liver disease. Published estimates of fatality are high among certain populations of chronic HCV patients, with liver-specific causes being an important contributor. Understanding current HCV mortality rates is important for quantifying the total burden of HCV disease.

A cost evaluation of peritoneal dialysis and hemodialysis in the treatment of end-stage renal disease in Sao Paulo, Brazil.

OBJECTIVE: Conventional hemodialysis (HD) predominates over peritoneal dialysis (PD) around the world. Prospective and comparative studies comparing the costs of these modalities are scarce. In the present prospective assessment, we describe the resources used and total patient costs for both HD and PD. ♢ METHODOLOGY: We assessed 249 patients on HD and 228 on PD. All patients were 18 years of age or older and on stable dialysis. The information was collected at three points over 1 year, using standard questionnaires. The sources for costs were the Brazilian public and private health care systems. Societal perspective was considered. ♢ STATISTICAL ANALYSIS: Core trends and dispersions were measured. Regression models assessed the impact of modality on the average total cost per patient per year. ♢ RESULTS: Of the 249 HD patients and 228 PD dialysis patients, 189 (74%) and 160 (70%) respectively completed follow-up. The mean age for women was 55.8 years; for men, it was 59.8 years (p = 0.001). The average total cost per patient-year was US$28 570 for HD and US$27 158 for PD. By category, the costs consisted of direct medical-hospital costs (82.3% for HD, 86.5% for PD), direct nonmedical costs (5.3% for HD, 3.7% for PD), and indirect costs (12.4% for HD, 9.8% for PD). Overall costs were less for PD patients than for their HD counterparts (p = 0.025). ♢ CONCLUSIONS: Maintenance dialysis represented the most important source of costs for both modalities; loss of productivity incurred significant costs. Future studies should contemplate the social consequences arising from each modality.

Health-related quality of life of patients recieving hemodialysis and peritoneal dialysis in São Paulo, Brazil: a longitudinal study.

OBJECTIVES: The aim of this study was to evaluate quality of life in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) in São Paulo, Brazil. METHODS: Inclusion criteria for this is a 1-year prospective study included being 18 years of age or older and clinically stable receiving chronic dialysis. Quality of life was measured using the SF-12 and the Kidney Disease Quality of Life questionnaires at baseline, 6 months, and 12 months. Patients who completed the surveys for all three periods were evaluated. Differences in quality of life scores were measured using univariate and multivariate regression analyses. RESULTS: One hundred eighty-nine of 249 (76%) HD patients and 161 of 228 (71%) PD patients completed all three surveys. The PD group was older and a larger number had diabetes. PD patients consistently had higher scores than HD patients at all three measurement periods for patient satisfaction (P = 0.002, P = 0.005, and P = 0.005, respectively), encouragement/support from staff (P = 0.003, P = 0.017, and P = 0.029, respectively), and burden of kidney disease (P = 0.003, P = 0.017, and P = 0.057, respectively). The HD group had a greater percent of patients who clinically improved from baseline to 12 months compared to PD patients for sleep quality, social support, encouragement/support from staff, and overall health. Scores for other dimensions of the Kidney Disease Quality of Life and SF-12 questionnaires were not significantly different between the PD and HD groups. CONCLUSIONS: The results provide evidence that PD and HD patients have equivalent health-related quality of life in several domains, although the former performed better in some quality of life domains despite being older and having more comorbidities.