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Estimation of Hepatitis C Prognosis ...

Erman, Aysegul .

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Estimation of Hepatitis C Prognosis to Inform Treatment Prioritization Decisions.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Estimation of Hepatitis C Prognosis to Inform Treatment Prioritization Decisions./
作者:	Erman, Aysegul .
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2020,
面頁冊數:	212 p.
附註:	Source: Dissertations Abstracts International, Volume: 82-01, Section: B.
Contained By:	Dissertations Abstracts International82-01B.
標題:	Health care management. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=13877702
ISBN:	9798662389458

Estimation of Hepatitis C Prognosis to Inform Treatment Prioritization Decisions.
Erman, Aysegul .

Estimation of Hepatitis C Prognosis to Inform Treatment Prioritization Decisions. - Ann Arbor : ProQuest Dissertations & Theses, 2020 - 212 p.

Source: Dissertations Abstracts International, Volume: 82-01, Section: B.

Thesis (Ph.D.)--University of Toronto (Canada), 2020.

This item must not be sold to any third party vendors.

Chronic hepatitis C (CHC) is a leading cause of hepatic fibrosis and cirrhosis. Fortunately, treatment has been revolutionized by the recently introduced direct-acting antivirals (DAAs). However, prompt access to DAA therapy remains a challenge owing to exorbitant drug costs, as well as other health system constraints. Given that HCV disease progression is highly variable, delaying curative treatment could have varying levels of health impact for different CHC subpopulations. To address these issues, the three studies presented in this thesis aim to 1) derive updated estimates of the natural history of HCV, 2) explore the variability in disease progression, and 3) use these prognostic estimates to help inform decisions on the prioritization of highly effective but costly DAA therapy. The first study derived updated estimates of HCV-related liver disease progression (i.e., FPRs, or fibrosis progression rates) through a systematic review and meta-analysis of the current literature evaluating hepatic fibrosis in treatment-naive individuals with CHC; and explored sources of heterogeneity. Stratified analysis revealed substantial heterogeneity across study populations.The second study complemented the biopsy-based estimates of HCV disease progression derived in the first study by generating alternative estimates of prognosis (i.e., LSPR or liver stiffness progression rates) based on a newer non-invasive assessment of liver disease through a systematic review and meta-analysis of the literature on transient elastography (TE)-based assessment of hepatic fibrosis in treatment-naive individuals with CHC. The study suggested that non-invasive prognosis of HCV is consistent with FPRs in predicting time-to-cirrhosis. However, the current literature was limited and more longitudinal studies of liver stiffness are needed to obtain refined estimates. The third study employed detailed information on HCV prognosis obtained from meta-regression models derived from the first study to help inform treatment prioritization decisions by quantifying the health impact (i.e., life expectancy and quality-adjusted life expectancy) associated with delaying DAA therapy for various CHC subgroups using decision-analytic methods. Taken together these studies present detailed prognostic information for various subpopulations of patients. The data presented in these studies should be a valuable resource for patients, clinicians, and clinical policymakers in the DAA era.

ISBN: 9798662389458Subjects--Topical Terms:

2122906
Health care management.
Subjects--Index Terms:

Decision analysis

Estimation of Hepatitis C Prognosis to Inform Treatment Prioritization Decisions.
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