studies

288A AASLD ABSTRACTS HEPATOLOGY, October, 2015
the UK-PBC algorithm predicts a significant decrease in risk for
liver transplant and liver-related death in patients treated with
OCA+UDCA relative to placebo+UDCA. OCA has the potential
to be an important new treatment option for PBC patients
unable to achieve adequate response with UDCA.
Disclosures:
Richard Pencek - Employment: Intercept Pharmaceuticals; Stock Shareholder:
Intercept Pharmaceuticals
Tracy J. Mayne - Employment: Intercept Pharmaceuticals
Tonya Marmon - Employment: Intercept Pharmaceuticals, Inc; Stock Shareholder:
Intercept Pharmaceuticals, Inc
David Shapiro - Employment: Inttercept Pharmaceuticals; Management Position:
Intercept Pharmaceuticals; Stock Shareholder: Intercept Pharmaceuticals
The following authors have nothing to disclose: Marco Carbone, George F. Mells
156
Costs per Diagnosed Liver Disease Stage Among Individuals
with Chronic Hepatitis C Virus in the Veterans
Health Administration
Jennifer R. Kramer 1 , Peter Richardson 1 , Danielle Liffmann 2 , Hashem
B. El-Serag 1 , David B. Rein 2 ; 1 Department of Medicine, Michael E.
DeBakey VA Medical Center and Baylor College of Medicine,
Houston, TX; 2 NORC at the University of Chicago, Chicago, IL
Background: The prevalence of hepatitis C virus (HCV) infection
in the Veteran Health Administration (VHA) is high, but
previous research has not evaluated the costs of medical care
for diagnosed patients. Methods: We used the VHA HCV
Clinical Case Registry and Health Economics Resource Center
average cost data of inpatient, outpatient, and long-term care
to estimate the incremental annual cost of diagnosed HCV.
We compared the total healthcare costs of HCV antibody and
RNA + patients (cases) to HCV antibody + but HCV RNA -
patients (controls) identified from FY 1999 to 2009. Cases
were matched 1:1 to all available controls using a propensity
score that included demographic and clinical characteristics.
Patients were required to have an available AST/platelet ratio
(APRI) value in the index year (year of the earliest RNA test)
and one subsequent year. In each year, we classified patients
using ICD-9 codes and lab data (highest APRI in year) into 8
clinical stages: APRI 2, decompensated
cirrhosis (DCC), hepatocellular carcinoma (HCC),
transplant/post-transplant care, and death while infected with
HCV. Patients with DCC or HCC prior to HCV index date
were excluded. We estimated the incremental annual costs
for the 6 years after index date of each stage of HCV using
a hierarchical longitudinal two-part health expenditure model
(logistic, generalized linear model assuming a gamma distribution
and log link) and adjusted for clustering by incorporating
patient level random effects in both the logistic and gamma
models allowing these effects to be correlated. Results: There
were 157,303 patients (140,169 cases/17,134 controls) in
our source population; 52.8 years old (sd=8.0), 50.6% white,
25.9% Black, 96.7% male. The analysis set included 17,134
cases that were propensity matched to the 17,134 controls.
In 2009, 52.1% had APRI 2, 5.6% DCC, 0.7% HCC, 0.1% transplant,
and 3.9% died. Using 2015 dollars, on average, HCV RNA
- patients with an APRI