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Titolo:
An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy
Autore:
Han, SHB; Ofman, J; Holt, C; King, K; Kunder, G; Chen, P; Dawson, S; Goldstein, L; Yersiz, H; Farmer, DG; Ghobrial, RM; Busuttil, RW; Martin, P;
Indirizzi:
Univ Calif Los Angeles, Sch Med, Div Digest Dis, Dumont Liver Transplant Ctr, Los Angeles, CA 90095 USA Univ Calif Los Angeles Los Angeles CA USA 90095 Los Angeles, CA 90095 USA
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 6, volume: 6, anno: 2000,
pagine: 741 - 748
SICI:
1527-6465(200011)6:6<741:AEACAO>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
PASSIVE-IMMUNIZATION; SURFACE-ANTIGEN; VIRUS; PROPHYLAXIS; RECIPIENTS; RESISTANCE; POLYMERASE; MUTATIONS; CIRRHOSIS; RETRANSPLANTATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Han, SHB Univ Calif Los Angeles, Sch Med, Div Digest Dis, Dumont Liver Transplant Ctr, 10945 Le Conte Ave,2114PVUB, Los Angeles, CA 90095 USA Univ Calif Los Angeles 10945 Le Conte Ave,2114PVUB Los Angeles CA USA 90095
Citazione:
S.H.B. Han et al., "An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy", LIVER TRANS, 6(6), 2000, pp. 741-748

Abstract

Orthotopic liver transplantation (OLT) for hepatitis B virus (HBV) infection was limited until recently by poor graft and patient outcomes caused by recurrent HBV. Long-term immunoprophylaxis with hepatitis B immune globulin(HBIG) dramatically improved post-OLT survival, but recurrent HBV still occurred in up to 36% of the recipients. More recently, combination HBIG and lamivudine has been shown to effectively prevent HBV recurrence in patientspost-OLT. The aim of the current study is to determine long-term outcome and cost-effectiveness of using combination HBIG and lamivudine compared with HBIG monotherapy in patients who undergo OLT for HBV. A retrospective chart review identified 59 patients administered combination HBIG and lamivudine and 12 patients administered HBIG monotherapy as primary prophylaxis against recurrent HBV. Lamivudine, 150 mg/d, was administered orally indefinitely. HBIG was administered under a standard protocol (10,000 IU intravenously during the anhepatic phase, then 10,000 IU/d intravenously for 7 days, then 10,000 IU intravenously monthly) indefinitely A decision-analysis modelwas developed to evaluate the potential economic impact of prophylaxis against HBV with combination therapy compared with monotherapy. Recurrent HBV was defined as the reappearance of hepatitis B surface antigen (HBsAg) after its initial disappearance post-OLT, In the combination-therapy group, no patient redeveloped serum HBsAg or HBV DNA during mean follow-ups of 459 and 416 days, respectively. In the monotherapy group, 3 patients (25%) had reappearance of HBsAg in serum during a mean follow-up of 663 days. Combination therapy resulted in a dominant, cost-effective strategy with an average cost-effectiveness ratio of $252,111/recurrence prevented compared with $362,570/recurrence prevented in the monotherapy strategy. Combination prophylaxis with HBIG and lamivudine is highly effective in preventing recurrent HBV, may protect against the emergence of resistant mutants, and is significantly more cost-effective than HBIG monotherapy with its associated rate ofrecurrent HBV.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/04/20 alle ore 19:58:46