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dc.contributor.authorLinas, Benjamin P.en_US
dc.contributor.authorBarter, Devra M.en_US
dc.contributor.authorLeff, Jared A.en_US
dc.contributor.authorAssoumou, Sabrina A.en_US
dc.contributor.authorSalomon, Joshua A.en_US
dc.contributor.authorWeinstein, Milton C.en_US
dc.contributor.authorKim, Arthur Y.en_US
dc.contributor.authorSchackman, Bruce R.en_US
dc.date.accessioned2014-07-07T18:13:06Z
dc.date.issued2014en_US
dc.identifier.citationLinas, Benjamin P., Devra M. Barter, Jared A. Leff, Sabrina A. Assoumou, Joshua A. Salomon, Milton C. Weinstein, Arthur Y. Kim, and Bruce R. Schackman. 2014. “The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes.” PLoS ONE 9 (5): e97317. doi:10.1371/journal.pone.0097317. http://dx.doi.org/10.1371/journal.pone.0097317.en
dc.identifier.issn1932-6203en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12406853
dc.description.abstractBackground: As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. Methods: We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Main measures Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). Results: We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. Conclusions: We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and evaluating interventions addressing multiple points along the cascade rather than options focusing solely on single points.en
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pone.0097317en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026319/pdf/en
dash.licenseLAAen_US
dc.subjectComputer and Information Sciencesen
dc.subjectComputerized Simulationsen
dc.subjectMedicine and health sciencesen
dc.subjectHealth Careen
dc.subjectHealth Care Policyen
dc.subjectTreatment Guidelinesen
dc.subjectHealth Care Qualityen
dc.subjectEpidemiologyen
dc.subjectInfectious Disease Epidemiologyen
dc.subjectGastroenterology and hepatologyen
dc.subjectLiver diseasesen
dc.subjectInfectious hepatitisen
dc.subjectHepatitis Cen
dc.subjectInfectious Diseasesen
dc.subjectViral Diseasesen
dc.subjectHepatitisen
dc.titleThe Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomesen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS ONEen
dash.depositing.authorSalomon, Joshua A.en_US
dc.date.available2014-07-07T18:13:06Z
dc.identifier.doi10.1371/journal.pone.0097317*
dash.contributor.affiliatedKim, Arthur
dash.contributor.affiliatedSalomon, Joshua
dash.contributor.affiliatedWeinstein, Milton
dc.identifier.orcid0000-0003-3929-5515


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