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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedAuty SG, Griffith KN, Shafer PR
Improving access to high-value, high-cost medicines: the use of subscription models to treat hepatitis C using direct acting antivirals in the United States.
This paper discusses the use of state-sponsored subscription models to support increased access to high-value medications such as direct acting antivirals (DAAs) which can cure chronic Hepatitis C virus (HCV). The authors discuss the use of subscription models, a type of advanced purchase commitment (APC), to support increased access to high-value DAAs to treat HCV. They provide background information on HCV, its treatment, and state financing of prescription medications. They review the implementation of HCV subscription models in two states, Louisiana and Washington, and early evidence of their impact, as DAAs can cost upwards of $90,000 for treatment course.
AHRQ-funded; HS026395.
Citation: Auty SG, Griffith KN, Shafer PR .
Improving access to high-value, high-cost medicines: the use of subscription models to treat hepatitis C using direct acting antivirals in the United States.
J Health Polit Policy Law 2022 Dec 1;47(6):691-708. doi: 10.1215/03616878-10041121..
Keywords: Hepatitis, Medication, Chronic Conditions, Access to Care
Auty SG, Shafer PR, Dusetzina SB
Association of Medicaid managed care drug carve outs with hepatitis C virus prescription use.
The purpose of this cross-sectional study was to explore the relationship between Medicaid-covered Hepatitis C Virus (HCV) medication fills and Medicaid managed care organization (MCO) carve outs of direct-acting antiviral HCV medications. The researchers assessed changes in fills of Medicaid-covered direct-acting antiviral HCV medications in 4 states (Indiana, Michigan, New Hampshire, and West Virginia) that carved out these drugs from Medicaid MCOs between 2015 and 2017. The study found that carve outs were associated with a mean quarterly increase of 22.1 HCV prescriptions per 100 000 Medicaid enrollees. This was a relative increase of 86.3% compared with synthetic control states. Compared with each state's respective synthetic control, HCV prescription fills were associated with an increase of 11.5 HCV prescription fills per 100 000 Medicaid enrollees per quarter in Indiana, 36.6 in Michigan, 20.7 in West Virginia, and 43.6 in New Hampshire. The researchers concluded that carve outs of direct-acting antiviral HCV medications from Medicaid MCO prescription drug coverage were associated with significant increases in HCV medication use.
AHRQ-funded; HS026395.
Citation: Auty SG, Shafer PR, Dusetzina SB .
Association of Medicaid managed care drug carve outs with hepatitis C virus prescription use.
JAMA Health Forum 2021 Aug;2(8):e212285. 2021/08/27. doi: 10.1001/jamahealthforum.2021.2285..
Keywords: Medicaid, Hepatitis, Chronic Conditions, Medication
Tsui JI, Akosile MA, Lapham GT
Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV.
Hepatitis C and HIV are associated with opioid use disorders (OUD) and injection drug use. Medications for OUD can prevent the spread of HCV and HIV. The objective of this retrospective observational cohort study was to describe the prevalence of documented OUD, as well as receipt of office-based medication treatment, among primary care patients with HCV or HIV.
AHRQ-funded; HS026369.
Citation: Tsui JI, Akosile MA, Lapham GT .
Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV.
J Gen Intern Med 2021 Apr;36(4):930-37. doi: 10.1007/s11606-020-06389-7..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Hepatitis, Human Immunodeficiency Virus (HIV), Primary Care
Kolak MA, Chen YT, Joyce S
Rural risk environments, opioid-related overdose, and infectious diseases: a multidimensional, spatial perspective.
The authors adapted a risk environment framework to characterize rural southern Illinois and to describe the relations of risk environments, opioid-related overdose, HIV, Hepatitis C, and sexually transmitted infection rates between 2015 and 2017. They identified pervasive risk hotspots in more populated locales with higher rates of overdose and HCV incidence, whereas emerging risk areas were isolated to more rural locales that had experienced an increase in analgesic opiate overdoses and generally lacked harm-reduction resources. They also found that at-risk areas were characterized with underlying socioeconomic vulnerability but in differing ways, reflecting a nuanced and shifting structural risk landscape.
AHRQ-funded; HS022433.
Citation: Kolak MA, Chen YT, Joyce S .
Rural risk environments, opioid-related overdose, and infectious diseases: a multidimensional, spatial perspective.
Int J Drug Policy 2020 Nov;85:102727. doi: 10.1016/j.drugpo.2020.102727..
Keywords: Rural Health, Opioids, Substance Abuse, Medication, Hepatitis, Risk, Behavioral Health
Lo Re VR, Zeldow B, Kallan MJ
Risk of liver decompensation with cumulative use of mitochondrial toxic nucleoside analogues in HIV/hepatitis C virus coinfection.
This cohort study was conducted to determine if cumulative mitochondrial toxic nucleoside reverse transcriptase inhibitors (mtNRTI) use increased the risk of hepatic decompensation and death among patients coinfected with human immunodeficiency virus (HIV) and chronic hepatitis C virus (HCV). The findings suggest that cumulative mtNRTI use may increase the risk of hepatic decompensation and death in HIV/HCV coinfection and should be avoided when alternatives exist for HIV/HCV patients.
AHRQ-funded; HS018372.
Citation: Lo Re VR, Zeldow B, Kallan MJ .
Risk of liver decompensation with cumulative use of mitochondrial toxic nucleoside analogues in HIV/hepatitis C virus coinfection.
Pharmacoepidemiol Drug Saf 2017 Oct;26(10):1172-81. doi: 10.1002/pds.4258..
Keywords: Adverse Drug Events (ADE), Hepatitis, Human Immunodeficiency Virus (HIV), Medication, Patient Safety
Schmajuk G, Tonner C, Trupin L
Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.
Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown. This study found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients.
AHRQ-funded; HS023558; HS024412.
Citation: Schmajuk G, Tonner C, Trupin L .
Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.
Medicine 2017 Mar;96(13):e6528. doi: 10.1097/md.0000000000006528.
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Keywords: Hepatitis, Electronic Health Records (EHRs), Medication, Prevention, Patient Safety
Beckman AL, Bilinski A, Boyko R
New hepatitis C drugs are very costly and unavailable to many state prisoners.
This study found that in the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively).
AHRQ-funded; HS000055.
Citation: Beckman AL, Bilinski A, Boyko R .
New hepatitis C drugs are very costly and unavailable to many state prisoners.
Health Aff 2016 Oct;35(10):1893-901. doi: 10.1377/hlthaff.2016.0296.
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Keywords: Access to Care, Healthcare Costs, Hepatitis, Medication, Vulnerable Populations
Tetrault JM, Tate JP, Edelman EJ
Hepatic safety of buprenorphine in HIV-Infected and uninfected patients with opioid use disorder: the role of HCV-infection.
The purpose of this paper was to examine risk for buprenorphine (BUP)-associated hepatotoxicity among individuals with HIV and HCV. The authors found that liver enzymes and total bilirubin are rarely elevated in HIV-infected and uninfected patients receiving BUP, and that the risk of hepatotoxicity was greater in individuals infected with HIV, HCV, or HIV/HCV co-infection, who may benefit from increased monitoring.
AHRQ-funded; HS021112; HS018372.
Citation: Tetrault JM, Tate JP, Edelman EJ .
Hepatic safety of buprenorphine in HIV-Infected and uninfected patients with opioid use disorder: the role of HCV-infection.
J Subst Abuse Treat 2016 Sep;68:62-7. doi: 10.1016/j.jsat.2016.06.002.
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Keywords: Adverse Drug Events (ADE), Hepatitis, Human Immunodeficiency Virus (HIV), Medication, Risk
LaFleur J, Hoop R, Korner E
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
The researchers determined whether selected patient characteristics predicted discontinued therapy for reasons other than lack of efficcacy (non-LOE) using national databases of U.S. veterans. They found that predictors of greatest magnitude included comorbidities of myocardial infarction/congestive heart failure, renal disease, platelets 100/mm or more, Black race, albumin 3.5 mg/dl or more, sleep aid use, and poor persistence with antidepressants and antihypertensive agents.
AHRQ-funded; HS018582.
Citation: LaFleur J, Hoop R, Korner E .
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
Gastroenterol Nurs 2015 Nov-Dec;38(6):417-28. doi: 10.1097/sga.0000000000000214.
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Keywords: Chronic Conditions, Hepatitis, Medication, Patient Adherence/Compliance
Butt AA, Yan P, Shaikh OS
Virologic response and haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical settings.
This study sought to quantify treatment response, tolerability and occurrence of haematologic adverse events among persons treated with boceprevir (B0C)- and telaprevir (TPV)-containing regimens and compare them with historic controls treated with pegylated interferon/ribavirin (PEG/RBV) in actual clinical settings. It found that use of BOC- and TPV-containing regimens is superior to PEG/RBV for treatment of HCV genotype 1-infected persons.
AHRQ-funded; HS018372.
Citation: Butt AA, Yan P, Shaikh OS .
Virologic response and haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical settings.
J Viral Hepat 2015 Sep;22(9):691-700. doi: 10.1111/jvh.12375..
Keywords: Adverse Drug Events (ADE), Hepatitis, Medication
Pho MT, Jensen DM, Meltzer DO
Clinical impact of treatment timing for chronic hepatitis C infection: a decision model.
The researchers developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. They found that compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy.
AHRQ-funded; HS022433.
Citation: Pho MT, Jensen DM, Meltzer DO .
Clinical impact of treatment timing for chronic hepatitis C infection: a decision model.
J Viral Hepat 2015 Aug;22(8):630-8. doi: 10.1111/jvh.12412..
Keywords: Clinical Decision Support (CDS), Decision Making, Hepatitis, Medication, Outcomes
Burton MJ, Curtis JR, Yang S
Safety of biologic and nonbiologic disease-modifying antirheumatic drug therapy in veterans with rheumatoid arthritis and hepatitis B virus infection: a retrospective cohort study.
The researchers evaluated the safety of current treatment regimens for patients with rheumatoid arthritis (RA) and HBV in a large US cohort. They found a low rate of hepatotoxicity among a large cohort of US veterans with RA and HBV infection who were prescribed conventional RA therapies. Also, there were comparable rates of hepatotoxicity between biologic and nonbiologic disease-modifying anti-rheumatic drugs.
AHRQ-funded; HS023710.
Citation: Burton MJ, Curtis JR, Yang S .
Safety of biologic and nonbiologic disease-modifying antirheumatic drug therapy in veterans with rheumatoid arthritis and hepatitis B virus infection: a retrospective cohort study.
Arthritis Res Ther 2015 May 22;17:136. doi: 10.1186/s13075-015-0628-z..
Keywords: Arthritis, Patient Safety, Medication, Hepatitis, Adverse Drug Events (ADE)
Zhang S, Rust G, Cardarelli K
Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection.
The purpose of this study was to quantify the clinical and economic benefits of adherence to anti-retroviral therapy (ART), with a special focus on the subset of Medicaid enrollees with both HIV and HCV coinfection. It found that high-adherence to ART among Medicaid-enrolled patients with HIV and HCV coinfection is achievable – over 60 percent of such patients in this data-set had over 95 percent adherence to their ART.
AHRQ-funded; HS022444.
Citation: Zhang S, Rust G, Cardarelli K .
Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection.
AIDS Care 2015;27(7):829-35. doi: 10.1080/09540121.2015.1021745..
Keywords: Hepatitis, Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Medication
Kim DD, Hutton DW, Raouf AA
Cost-effectiveness model for hepatitis C screening and treatment: Implications for Egypt and other countries with high prevalence.
The researchers examined the cost-effectiveness of screening and treatment for HCV infection for asymptomatic, average-risk adults using a Markov decision analytic model. They found that, in Egypt, implementing a screening program using triple-therapy treatment (sofosbuvir with pegylated interferon and ribavirin) was dominant compared with no screening because it would have lower total costs and improve health outcomes.
AHRQ-funded; HS013853.
Citation: Kim DD, Hutton DW, Raouf AA .
Cost-effectiveness model for hepatitis C screening and treatment: Implications for Egypt and other countries with high prevalence.
Glob Public Health 2015;10(3):296-317. doi: 10.1080/17441692.2014.984742..
Keywords: Hepatitis, Screening, Healthcare Costs, Medication
Majid A, McAninch J, Morgan DJ
Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection.
This study aimed to assess early treatment discontinuation rates and identify underlying risk factors for discontinuation in a real-world boceprevir-based treatment cohort. Nearly half of patients started on boceprevir-based hepatitis C triple therapy stopped treatment by 24 weeks, with more discontinuing because of treatment intolerance than virologic failure. Early discontinuation was significantly more common in patients with comorbidities.
AHRQ-funded; HS018111.
Citation: Majid A, McAninch J, Morgan DJ .
Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection.
J Viral Hepat 2014 Aug;21(8):585-9. doi: 10.1111/jvh.12201.
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Keywords: Hepatitis, Adverse Events, Medication, Risk