swann-hepatitis

swann-hepatitis - Testing and Treatment for Hepatitis C:...

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1 1 Testing and Treatment for Hepatitis C: When and Where Dr. Julie Swann Georgia Institute of Technology H. Milton Stewart School of Industrial and Systems Engineering Feb 2007 Joint work with Daniel Faissol (GT), Paul Griffin (GT), Susan Griffin (CDC), Eser Kirkizlar (GT) 2 Hepatitis C Background ± Liver disease caused by blood-borne Hepatitis C virus (HCV) ² Liver disease is 10 th leading cause of death among US adults ± Most infected people are asymptomatic for decades ² 3.9 million people in US are currently infected but many are unaware ± Treatments are somewhat effective (~ 50%) ± Behavior is important to progression and secondary infections
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2 Disease Taxonomy ± Behavior {Impacts transmission (1), Impacts morbidity (2), Has no effect (3)} ± Infectious {Communicable (1), Transmissible (2), Not Infectious (3)} ± Length {Chronic (1), Acute (2)} ± Morbidity {Small effect (1), Large effect (2), Leads to death (3)} ± Population {Targets specific groups (1), Differs by risk (2), No discrimination (3)} ± Symptoms {Brief time to symptoms (1), Long time to symptoms (2), Asymptomatic(3)} ± Treatment {Cure (1), Improves quality of life (2), None (3)} *Genetic linkages are not well understood **HPV can lead to a chronic state (e.g., cervical cancer) 1 3 1 1 2 1 2 Treatment 1 2 3 2 1 1 1 or 2 Symptoms 3 2 2 2 2 2 1 or 2* Population 2 2 and 3 1, 2, or 3 2 and 3 1 and 3 1 2 Morbidity 2 1 1 or 2** 1 2 2 1 Length 1 3 2 2 2 2 3 Infectious 3 2 1 1 and 2 3 1 2 Behavior Malaria Lung Cancer Human Papillomavirus Hepatitis C Flu Chlamydia Asthma 4 Screening for Disease Presence ± Identify populations (at-risk) to test for disease ± Evaluate cost-effectiveness ² Prevalence of disease ² Accuracy and cost of test ² Progression and cost of disease ² Cost reduction through disease awareness (e.g., treatment or behavioral change) ± (Sometimes) determine frequency or timing
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3 5 Hepatitis C Findings ± Treatment of HCV is cost-effective ² Kim et al (1997), Salomon et al (2003), Neumann et al (2006), Saab et al (2002) ± Testing for HCV ² Yes for drug users (Castelnuovo et al 2006) or high risk groups (Gordon 1999) ² Not for pregnant women (Plunkett and Grobman 2005) or average adults (Singer and Younossi 2001) or post-transfusion patients (Pereira and Sanz 2000) ± Official recommendations ² USPHS & IDSA: HIV positive persons ² USPSTF: not general population (no other recommendations) ² CDC: High risk (drug users, medical staff) ² None comment on timing ± Our contribution: timing (and frequency), impact of behaviors 6 Other Findings ± Monte Carlo simulation of Markov models for disease progression or screening ² Goldie and Kuntz (2003), Rosenquist and Lindfors (1994), Sonnenberg et al (2000) ± Repeated screenings (usually equally spaced) ² Brenner et al (2006), Chen et al (2001), Siebert et al (2003), Paltiel et al (2005) ² Kaplan and Satten (2000): prevalence Æ interval ² Diehl et al (2006): computational testing ± Analytical approaches to timing ² Machine inspection and replacement (Eckles 1968, Smallwood and Sondik 1973, Ozekici and Pliska 1991, Grosfeld-Nir 1996) ² Medical screening (Parmigiani 1993, Zelen 1993) ² Timing of liver transplants (Alagoz et al 2004, 2006) ± Our contribution: analytical analysis of timing of unknown disease with behavioral impact
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swann-hepatitis - Testing and Treatment for Hepatitis C:...

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