Chidi, Alexis
(2015)
Evaluating Treatment of Chronic Liver Disease & Hepatocellular Carcinoma.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Chronic liver disease is a major cause of morbidity and mortality worldwide. More than 3 million patients are infected with chronic hepatitis C which, when left untreated, can result in liver cirrhosis, liver transplantation, hepatocellular carcinoma, and early mortality. Successful treatment of hepatitis C can dramatically reduce these risks, however the high cost of treatment may limit its use. Similarly, surgical intervention can be curative for patients with hepatocellular carcinoma, however nonclinical barriers may limit access to surgical intervention for medically eligible patients. The papers in this dissertation evaluated methods of improving access to and equitable utilization of available treatment options to interrupt the continuum of chronic liver disease. First, we compared the cost-effectiveness of two novel drug regimens for US Veterans with genotype 1 hepatitis C using various strategies to prioritize patients for treatment in light of resource constraints. While both drug regimens were cost-effective, we found that treating any eligible patient was less costly and more effective than prioritizing treatment of patients with advanced disease. Next, we determined the degree to which the current Medicaid policy restricting hepatitis C treatment to patients with advanced disease would lead to increased long-term costs and worse health outcomes for Medicare and the Centers for Medicare and Medicaid Services. We found that full access to hepatitis C treatment was cost saving and more effective compared to restricting treatment to patients with advanced disease from both perspectives. A full access strategy could also avert numerous future liver transplants, cases of hepatocellular carcinoma, and deaths. Finally, we evaluated geographic disparities in surgical intervention for hepatocellular carcinoma and determined the influence of physician recommendations on the type of treatment a patient ultimately receives. Interestingly, we found that urban patients who live closer to high volume centers are less likely to undergo surgical intervention. Furthermore, disparities tend to exist in referral for surgical intervention; once referred, most patients receive the recommended surgical procedure. These studies reveal opportunities to improve treatment of patients with hepatitis C and hepatocellular carcinoma, which could ultimately interrupt the continuum of chronic liver disease and improve health outcomes.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
27 July 2015 |
| Date Type: |
Publication |
| Defense Date: |
7 July 2015 |
| Approval Date: |
27 July 2015 |
| Submission Date: |
14 July 2015 |
| Access Restriction: |
5 year -- Restrict access to University of Pittsburgh for a period of 5 years. |
| Number of Pages: |
96 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Medicine > Clinical and Translational Science |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Chronic liver disease, hepatitis C, hepatocellular carcinoma, cost-effectiveness, decision analysis, health services research, health disparities |
| Date Deposited: |
27 Jul 2015 12:17 |
| Last Modified: |
27 Jul 2020 05:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/25618 |
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