studies

924A AASLD ABSTRACTS HEPATOLOGY, October, 2015
dasabuvir and ribavirin for 24 weeks (3D+R). This phase distributed
patients into post-treatment disease states, including
sustained virologic response (SVR), based on treatment efficacy.
The second phase followed the cohort’s post-treatment
progression through further liver fibrosis and death. Outcome
measures included lifetime costs (medical and pharmaceutical),
quality-adjusted life years (QALYs) and incremental cost-effectiveness
ratios (ICERs) associated with each treatment. SVR
and adverse event rates were based on phase III clinical trials.
Transition probabilities, utilities and medical costs were
extracted from published literature; treatment costs assumed
100% adherence and reflected wholesale acquisition costs
from December 2014 Red Book. Results: In a post liver-transplant
setting, the use of 3D+R had the lowest discounted overall
costs ($423,585) and highest gain in QALYs (11.3) compared
to NT ($724,757 cost, 8.25 QALYs) or PR48 ($658,411 cost,
8.73 QALYs). Use of 3D+R also generated net cost-savings
for the healthcare system given the lower cost of this regimen
($169,018) compared to the incremental discounted costs of
NT ($301,172) and PR48 ($234,826). Conclusions: Compared
to other regimens for treatment of post-liver transplant
genotype 1 HCV recurrence, 3D+R is a cost-effective option
that generates significantly higher quality-adjusted survival and
lower costs. Use of 3D+R in the post-liver transplant population
could also generate net cost savings for the healthcare system
compared to previous standards of care.
1463
Gut Microbiota Alterations are an Independent Prognostic
Factor for 90-day hospitalization in Cirrhosis
Jasmohan S. Bajaj 1 , Naga Betrapally 2 , Douglas M. Heuman 1 , Melanie
White 1 , Ariel Unser 1 , Edith A. Gavis 1 , Phillip B. Hylemon 1 ,
Leroy Thacker 1 , Masoumeh Sikaroodi 2 , Patrick M. Gillevet 2 ; 1 VCU
and McGuire VAMC, Richmond, VA; 2 Microbiome Analysis Center,
Geoge Mason University, Manassas, VA
Gut microbiota abnormalities (dysbiosis) worsens with the progression
of cirrhosis in cross-sectional studies. However the
impact of fecal dysbiosis on hospitalizations in cirrhotics is
unclear. Aim: Define the association of dysbiosis with 90-day
hospitalizations in cirrhosis. Methods: 284 cirrhotics (56 yrs,
MELD 11, 35% alcohol, 38% prior HE, 30% Diabetes) underwent
stool multi-tagged sequencing analysis to determine the
relative microbial family abundances including beneficial commensals
such as Lachnospiraceae, Ruminococceae & Clostridiales
XIV. Subjects were followed for 90 days and non-elective
hospitalizations were noted. Binary logistic regression using
90-day hospitalizations as the dependent variable with MELD,
PPI use, HE, alcohol etiology, diabetes, and bacteria significant
on univariate analyses as predictors was performed.
Results: Of the 284, 25 were lost to follow-up and 5 had elective
hospitalizations. 94 (37%) were non-electively hospitalized
within 90 days (median 35, IQR 21-78 days). The major
(n=87) hospitalization reason were liver-related, thus no further
sub-analysis was done(HE=46, Infection=14, Anasarca=13,
GI bleed=10, others=4). Those who were hospitalized had
a worse cirrhosis severity, were younger, and higher PPI use
(Table). Alcoholic etiology was similar (25% vs. 18%, p=0.4).
Stool microbiota showed a lower relative abundance of Bacteroidaceaeae
(11% vs 26%, p=0.002), Lachnospiraceae (8%
vs 14%,p=0.001), Ruminococceae (3% vs. 7%,p