Economic Impact of Treatment Options for Hepatic Encephalopathy

Size: px
Start display at page:

Download "Economic Impact of Treatment Options for Hepatic Encephalopathy"

Transcription

1 Economic Impact of Treatment Options for Hepatic Encephalopathy Carroll B. Leevy, M.D. 1 ABSTRACT Complications of chronic liver disease, such as hepatic encephalopathy (HE), can have a substantial impact on the economic burden of liver disease. In the United States, a report of 162,734 inpatient hospital discharges included HE or unspecified encephalopathy diagnoses in 2004, a 234% increase over data from Hospital charges for HE and HE-related conditions also increased from 1993 to 2004 in the United States. Mean hospital charges have increased despite a steady reduction in the mean duration of stay, a trend that may reflect advances in treatment. Several studies have provided data about the cost-effectiveness of rifaximin and lactulose as treatments for HE. These studies showed that, although rifaximin costs more per tablet than lactulose, rifaximin is more cost-effective for long-term therapy. Further studies are warranted to more fully evaluate the relative long-term cost-effectiveness of specific HE treatments. KEYWORDS: Hepatic encephalopathy, health care utilization, lactulose, rifaximin National Health Interview Survey data from 1995 (adjusted to 1998) indicate that an estimated 5.5 million individuals in the United States have been diagnosed with chronic liver disease and cirrhosis. 1 These findings, in the absence of more recent data, suggest that the economic burden of chronic liver disease, along with that of associated conditions such as cirrhosis and chronic hepatitis C, is substantial. The total direct cost associated with chronic liver disease, cirrhosis, and chronic hepatitis C was more than $2.1 billion, according to the same adjusted National Health Interview Survey data and also data from Group Health Cooperative of Puget Sound for Most of that cost resulted from inpatient hospital stays and prescribed medication (Fig. 1). 1 The estimated indirect cost of lost wages due to hospitalization and time associated with visits to physician offices, hospital emergency rooms, and outpatient departments totaled more than $272 million annually for these conditions. 1 Given that these data were based on 1998 estimates, current costs related to chronic liver disease are undoubtedly higher. Complications such as hepatic encephalopathy (HE) are not uncommon in patients with chronic liver disease and contribute to its overall economic burden. HE is a neuropsychiatric syndrome that affects consciousness, cognitive abilities, behavior, and neuromuscular function. Symptoms range from subtle neuropsychological impairment in patients with minimal HE to coma in the most severe cases. 2,3 In studies that reported the prevalence of HE, overt HE developed in 28% to 41% of patients with cirrhosis, 4 6 and minimal HE was found in 22% to 62%. 5,7 10 Up to 51% of patients who undergo placement of transjugular intrahepatic portosystemic shunts for the treatment of complications related to portal hypertension have also been reported to develop HE The economic burden of treating HE varies, depending on the severity of the condition, with more 26 1 New Jersey Medical School Liver Center, Newark, New Jersey. Address for correspondence and reprint requests: Carroll B. Leevy, M.D., New Jersey Medical School Liver Center, 90 Bergen Street, Suite 2100, Newark, NJ Current Concepts in the Management of Hepatic Encephalopathy; Guest Editor, Emmet B. Keeffe, M.D., M.A.C.P. Semin Liver Dis 2007;27(suppl 2): Copyright # 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) DOI /s ISSN

2 ECONOMIC IMPACT OF TREATMENT OPTIONS FOR HE/LEEVY 27 Figure 1 Total direct cost (millions, US dollars) of chronic liver disease, cirrhosis, and chronic hepatitis C. Data are from the 1995 National Health Interview Survey (adjusted to 1998) and Group Health Cooperative of Puget Sound for *No visits to the emergency room for hepatitis C were reported by the National Hospital Ambulatory Medical Care Survey in (From American Gastroenterological Association. The Burden of Gastrointestinal Diseases. Chapter 5: Hepatobiliary and pancreatic disorders. Available at: Accessed January 5, 2007.) severe cases requiring management in an intensive care unit. 11 The economic impact may also depend on the specific treatment administered. This article presents an overview of the economic burden of HE and reviews the cost-effectiveness of two treatments for HE: the nonabsorbable disaccharide lactulose and the nonabsorbable antibiotic rifaximin. ECONOMIC IMPACT OF HE Estimates of the economic burden of inpatient hospital treatment for HE can be obtained from the Nationwide Inpatient Sample (NIS), a collection of databases developed as part of the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality. 12 The NIS database contains data from 8 million hospital stays each year and discharge information from 1004 hospitals in 37 states. Specific health care utilization data for HE and HE-related conditions are tracked using codes listed in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Based on data from the NIS database, the number of hospitalizations for a principal diagnosis of HE (code 572.2) or unspecified encephalopathy (code ) steadily increased during the period from 1993 to 2004 (Fig. 2). 12 Hospitalizations for HE-related conditions, including alcoholic cirrhosis (code 571.2; Fig. 2), and nonalcoholic cirrhosis (code 571.5) also increased during this time period. 12 The total number of discharges for a principal diagnosis of HE (code 572.2) or unspecified encephalopathy (code ) increased 180%, from 18,154 in 1993 to 50,962 in 2004 (Table 1). All-listed diagnoses of HE, which encompass all diagnoses that coexisted with HE or unspecified encephalopathy at the time of admission or that developed during the hospital stay and affected treatment or duration of stay, increased 234%, from 48,729 in 1993 to 162,734 in 2004 (Table 1). 12 The difference in principal and all-listed diagnoses for HE suggests that HE is infrequently coded as the principal diagnosis and that the reported prevalence may be underestimated. One factor that may have contributed to the increase in conditions related to chronic liver disease, including HE, is an increase in viral hepatitis cases. The number of outpatient clinic visits for chronic hepatitis C increased from 756,774 in 2000 to 1,237,708 in 2002, an Figure 2 Trends in hospitalization for principal diagnoses of HE (code 572.2) in the United States from 1993 to HE, hepatic encephalopathy. (From Agency for Healthcare Research Quality. HCUPnet: Healthcare Cost and Utilization Project. Available at: &Form=SelQUERYTYPE&JS=Y&Action=%3E%3ENext%3E% 3E&_QUERYTYPE=Trends. Accessed February 2007.)

3 28 SEMINARS IN LIVER DISEASE/VOLUME 27, SUPPLEMENT Table 1 Hospital Discharges for HE or Unspecified Encephalopathy in the United States, 2004 Diagnosis (ICD-9-CM Code) Principal Diagnoses All-Listed* Hepatic encephalopathy (572.2) 42,269 98,669 Encephalopathy, unspecified (348.30) ,065 Total 50, ,734 *Includes all diagnoses that coexisted at the time of admission or that developed during the hospital stay and affected treatment or duration of stay. Data from Agency for Healthcare Research Quality. HCUPnet: Healthcare Cost and Utilization Project. Available at: ahrq.gov/hcupnet.jsp?id=dbe1ccf502e0c25d&form=selquery TYPE&JS=Y&Action=%3E%3ENext%3E%3E&_QUERYTYPE= Trends. Accessed February HE, hepatic encephalopathy; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification. increase that was likely due to increased awareness among patients and health care providers. 13 To estimate the potential future impact of chronic hepatitis C, Wong and colleagues conducted a Markov statistical simulation based on 1991 data from the National Health and Nutrition Examination Survey III. 14 These authors predicted that, between the years 2010 and 2019, deaths due to hepatitis C related chronic liver disease would total 181,300 for the 10-year period, a 2-fold increase over the number of deaths reported in As with hospital discharges, aggregate hospital charges (i.e., the national bill ) for primary diagnoses of HE (code 572.2) and unspecified encephalopathy (code ) also increased, from approximately $216 million in 1993 to more than $1.1 billion in Based on 2004 data from the NIS database, patients with a principal diagnosis of HE or unspecified encephalopathy incurred mean charges per hospital stay of $22,236 and $24,378, respectively (Table 2). The NIS database does not provide data on the duration of hospital stay and associated charges for all-listed diagnoses; consequently, these charges may be estimated from charges associated with related conditions. Although such an estimate is likely to be exaggerated, the data suggest that principal diagnoses of conditions that may lead to or coexist with HE, such as portal hypertension and cirrhosis, were associated with costly hospital stays (Table 2). 12 The combined mean charges per hospital stay for principal diagnoses of HE (code 572.2) and unspecified encephalopathy (code ) increased 90% from $11,910 in 1993 to $22,607 in 2004 (Fig. 3). 12 Interestingly, this increase was associated with a decrease in the mean duration of stay; the combined mean duration of stay for HE and unspecified encephalopathy decreased from 8.2 days in 1993 to 5.6 days in 2004, a reduction of 32% (Fig. 3 and Table 2). 12 The decrease in the duration of hospital stay may reflect advances in HE treatment. As noted, the NIS database has several limitations, including the potential for underestimating the costs associated with HE due to the lack of complete hospital data (e.g., duration of stay, hospital charges) for all-listed diagnoses. Nevertheless, the data suggest that direct costs associated with HE contribute to the overall costs of chronic liver disease. 12 COST-EFFECTIVENESS OF RIFAXIMIN VERSUS LACTULOSE The nonabsorbable disaccharide lactulose is the mainstay treatment for HE, although antibiotics, such as neomycin and metronidazole, are also commonly prescribed. 11 The nonabsorbable antibiotic rifaximin has been licensed in Europe for the treatment of various conditions, including HE, for 20 years. 15,16 In the United States, where rifaximin is currently approved for the treatment of travelers diarrhea caused by noninvasive strains of Escherichia coli, 15 a randomized, double-blind, placebo-controlled phase III investigation of the efficacy of rifaximin for the treatment of HE is ongoing. The cost-effectiveness of rifaximin for the treatment of HE has most often been compared with that of lactulose One retrospective chart review conducted at a single center included 145 patients with HE; these patients had not undergone liver transplantation and had received treatment with lactulose 60 ml/d for at least 6 months, followed by treatment with rifaximin 1200 mg/d for at least 6 months. 19 Table 2 Hospital Stay Data for HE-Related Conditions* in the United States, 2004 Diagnosis (ICD-9-CM Code) Total Number of Discharges Mean Duration of Stay (d) Mean Charges ($) Hepatic encephalopathy (572.2) 42, ,236 Encephalopathy, unspecified (348.30) ,378 Portal hypertension (572.3) ,766 Cirrhosis Alcoholic (571.2) 53, ,598 Nonalcoholic (571.5) 37, ,259 *Principal diagnoses only. Data from Agency for Healthcare Research Quality. HCUPnet: Healthcare Cost and Utilization Project. Available at: HCUPnet.jsp?Id=DBE1CCF502E0C25D&Form=SelQUERYTYPE&JS=Y&Action=%3E%3ENext%3E%3E&_QUERYTYPE=Trends. Accessed February HE, hepatic encephalopathy; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification.

4 ECONOMIC IMPACT OF TREATMENT OPTIONS FOR HE/LEEVY 29 Figure 3 Trends in hospital charges and length of hospital stay for principal diagnosis of HE (code 572.2) and other types of encephalopathy (codes ) from 1993 to 2004 in the United States. HE, hepatic encephalopathy. (From Agency for Healthcare Research Quality. HCUPnet: Healthcare Cost and Utilization Project. Available at: F502E0C25D&Form=SelQUERYTYPE&JS=Y&Action=%3E%3ENext%3E%3E&_QUERYTYPE=Trends. Accessed February 2007.) During the rifaximin treatment period, patients had significantly fewer hospitalizations (p < 0.001) and shorter hospital stays (p < 0.001) (Table 3). Hospital charges were approximately 4 times lower during the rifaximin treatment period than during the lactulose treatment period, a difference that may have been attributable to shorter stays associated with lower posttreatment severity of HE with rifaximin (Table 3). Another retrospective study evaluated the costs of treatment for 39 patients with stage 2 HE awaiting liver transplantation who had received lactulose 60 g/d or rifaximin 1200 mg/d. 17 The total number of hospitalizations and the average length of stay favored rifaximin (Table 3). The total drug cost per month was higher for rifaximin ($620) than for lactulose ($50). However, the mean total cost per year for hospitalization, emergency room visits, and drug treatment was 40% lower for patients who received rifaximin than for those who received lactulose; in addition, the mean annual total cost of therapy per patient was $5327 lower with rifaximin. The authors suggested that the initially lower economic cost associated with lactulose was negated when long-term costs, which included the cost of hospitalization, were taken into consideration. In addition to these retrospective studies reporting hospital and cost outcomes, Spiegel et al conducted a hypothetical analysis based on a systematic literature review and statistical modeling to evaluate the costeffectiveness of HE treatments. 18 This study evaluated the cost-effectiveness of 6 treatment strategies: rifaximin, lactulose, lactitol, neomycin monotherapy, lactulose Table 3 Studies Comparing Cost-Effectiveness of Rifaximin with Lactulose Outcome Parameter Rifaximin (1200 mg/d) Leevy 19 Patients, n Hospitalizations, n, mean 0.5* 1.6 Duration per hospitalization, days, mean 2.5* 7.3 Lactulose (60 g/d) Hospital charges per patient, $ y 14,222 56,635 HE stage 3 or 4 9 (6)* 36 (25) posttreatment, n (%) Asterixis posttreatment, n (%) 91 (63)* 135 (93) Neff et al 17 Patients, n Hospitalizations, n 3 19 Duration per hospitalization, days, mean 3.5 z 5.0 Annual cost of therapy ,285 per patient, $, mean Total annual costs, $, mean 119, ,839 *p < versus lactulose. y Calculated in 2005 dollars based on 2003 data from the HCUP for a principal diagnosis of HE (572.2). p < Calculation took into account annual cost of hospitalization, emergency room visits, and drug costs. Data from Leevy CB, Phillips JA. Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci 2007;52: ; and Neff GW, Kemmer N, Zacharias VC, et al. Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy. Transplant Proc 2006;38: HE, hepatic encephalopathy.

5 30 SEMINARS IN LIVER DISEASE/VOLUME 27, SUPPLEMENT Table 4 Summary of Cost-Effectiveness of Rifaximin versus Lactulose in the Treatment of HE Measure Cost-Effectiveness Frequency and duration of hospitalizations Hospitalization charges Total drug cost per month Total cost of hospitalization, emergency room visits, and drug costs rifaximin < lactulose rifaximin < lactulose rifaximin > lactulose rifaximin < lactulose Data from Leevy CB, Phillips JA. Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci 2007;52: ; and Neff GW, Kemmer N, Zacharias VC, et al. Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy. Transplant Proc 2006;38: HE, hepatic encephalopathy. followed by rifaximin, and no treatment. Patients were 50 years of age and had either stage 1 (minimal) or stage 2 HE. The total lifetime combined cost of care was estimated to be lowest for lactulose ($56,967) and highest for rifaximin ($75,671). Treatment with lactulose followed by rifaximin was calculated to be the most effective with regard to discounted cost per life-years gained (6.9 life-years vs 3.86 life-years for no treatment), but it was less cost-effective than lactulose monotherapy. The authors concluded that rifaximin is not cost-effective as first-line therapy but that it may be highly costeffective when used as salvage therapy for patients who do not respond to lactulose. 18 To date, the findings of this study have only been published as a meeting abstract and have not yet appeared in a peer-reviewed journal. Because this study was a hypothetical modeling analysis based on a narrow patient population, it is difficult to draw conclusions about the direct cost of rifaximin compared with other treatments or about the costeffectiveness of these HE treatments in patients with moderate or severe HE. In summary, rifaximin appears to be more costeffective than lactulose Two retrospective chart reviews showed that rifaximin treatment resulted in lower health care utilization and costs compared with lactulose (Table 4) and suggested that rifaximin may provide long-term economic benefit. CONCLUSION The economic burden of chronic liver disease, cirrhosis, and chronic hepatitis C is substantial, contributing to estimated annual direct costs of more than $2.1 billion and indirect costs of more than $272 million. In recent years, HE diagnoses and charges for inpatient HE treatment have increased, raising the overall economic impact of chronic liver disease. An increase in hospital charges for inpatient HE treatment has been coupled with a decrease in the mean duration of hospital stays for HE treatment. The reason for the trend toward shorter hospital stays is unclear, but advances in HE treatment may play a role. The costs associated with HE treatment can affect the overall economic burden of the condition. Studies of the cost-effectiveness of specific HE treatments are lacking, but several published studies have compared the cost-effectiveness of the nonabsorbable disaccharide lactulose with that of the nonabsorbable antibiotic rifaximin. These studies showed that, although rifaximin costs more per month than lactulose, rifaximin therapy is associated with lower hospital utilization, hospital charges, and overall cost than lactulose. Over the course of long-term therapy, rifaximin was found to be more cost-effective than lactulose. In conclusion, when the long-term economic benefits of various HE treatments are considered, a higher short-term economic burden of newer treatments may provide greater overall economic benefits over the long term. ABBREVIATIONS HCUP Healthcare Cost and Utilization Project HE hepatic encephalopathy ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification NIS Nationwide Inpatient Sample REFERENCES 1. American Gastroenterological Association. The Burden of Gastrointestinal Diseases. Chapter 5: Hepatobiliary and pancreatic disorders. Available at: Documents/burden-report.pdf. Accessed January 5, Mas A. Hepatic encephalopathy: from pathophysiology to treatment. Digestion 2006;73(suppl 1): Abou-Assi S, Vlahcevic ZR. Hepatic encephalopathy: metabolic consequence of cirrhosis often is reversible. Postgrad Med 2001;109:52 60, Amodio P, Del Piccolo F, Petteno E, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol 2001;35: Romero-Gomez M, Boza F, Garcia-Valdecasas MS, et al. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol 2001; 96: Ytting H, Moller S, Henriksen JH, et al. Prognosis in patients with cirrhosis and mild portal hypertension. Scand J Gastroenterol 2006;41: Hartmann IJ, Groeneweg M, Quero JC, et al. The prognostic significance of subclinical hepatic encephalopathy. Am J Gastroenterol 2000;95: Kircheis G, Wettstein M, Timmermann L, et al. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology 2002;35: Groeneweg M, Quero JC, De Bruijn I, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 1998;28:45 49

6 ECONOMIC IMPACT OF TREATMENT OPTIONS FOR HE/LEEVY Das A, Dhiman RK, Saraswat VA, et al. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol 2001;16: Han MK, Hyzy R. Advances in critical care management of hepatic failure and insufficiency. Crit Care Med 2006;34: S225 S Agency for Healthcare Research Quality. HCUPnet: Healthcare Cost and Utilization Project. Available at: hcupnet.ahrq.gov/hcupnet.jsp?id¼dbe1cc F502E0C25DForm¼SelQUERYTYPEJS=YAction¼%3 E 3ENext3E3E_QUERYTYPE¼Trends. Accessed February Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, Am J Gastroenterol 2006;101: WongJB,McQuillanGM,McHutchisonJG,PoynardT. Estimating future hepatitis C morbidity, mortality, and costs in the United States. Am J Public Health 2000;90: Koo HL, DuPont HL. Current and future developments in travelers diarrhea therapy. Expert Rev Anti Infect Ther 2006;4: Scarpignato C, Pelosini I. Experimental and clinical pharmacology of rifaximin, a gastrointestinal selective antibiotic. Digestion 2006;73(suppl 1): Neff GW, Kemmer N, Zacharias VC, et al. Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy. Transplant Proc 2006;38: Spiegel B, Huang E, Esrailian E. Is rifaximin cost-effective in the management of hepatic encephalopathy? Gastroenterology 2006;130:A Leevy CB, Phillips JA. Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci 2007;52:

{ Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta Analysis}

{ Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta Analysis} { Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta Analysis} {Dong Wu, Shu-Mei Wu, Jie Lu, Ying-Qun Zhou, Ling Xu, and Chuan-Yong Guo} Noor Al-Hakami, Pharm

More information

Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial

Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial Marcus R. Pereira A. Study Purpose Hepatic encephalopathy is a common complication

More information

Severe Acute Hepatic Encephalopathy in Cirrhotic patients: The gut remains an important target of therapy

Severe Acute Hepatic Encephalopathy in Cirrhotic patients: The gut remains an important target of therapy Severe Acute Hepatic Encephalopathy in Cirrhotic patients: The gut remains an important target of therapy Rohit Sawhney, Rajiv Jalan Liver Failure Group, Institute for Liver and Digestive Health, University

More information

Developing Innovative Therapeutics for People with Orphan Liver Disease

Developing Innovative Therapeutics for People with Orphan Liver Disease Developing Innovative Therapeutics for People with Orphan Liver Disease PIPELINE PROGRESS AND FIRST QUARTER 2015 EARNINGS UPDATE NASDAQ: OCRX Forward-Looking Statements Certain statements in this presentation

More information

Presented by: Jean Yoo-Campbell, Matthew Konerman, Monica Konerman, Jean Yoo Campbell, Christian Gocke, Eunpi Cho Donald Lynch

Presented by: Jean Yoo-Campbell, Matthew Konerman, Monica Konerman, Jean Yoo Campbell, Christian Gocke, Eunpi Cho Donald Lynch Bass N.M., et. al. N Engl J Med 2010; 362:1071-1081 Presented by: Jean Yoo-Campbell, Matthew Konerman, Monica Konerman, Jean Yoo Campbell, Christian Gocke, Eunpi Cho Donald Lynch Faculty Advisor: Dr. Fred

More information

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum OVERVIEW OF THE FELLOWSHIP The goal of the AASLD NP/PA Fellowship is to provide a 1-year postgraduate hepatology training program for nurse practitioners and physician assistants in a clinical outpatient

More information

The Multidimensional Burden of Hepatic Encephalopathy

The Multidimensional Burden of Hepatic Encephalopathy The Multidimensional Burden of Project ID: 11-0014-NL-5 Credit Designation In the United States, chronic liver disease (CLD) is one of the leading causes of morbidity and mortality and affects approximately

More information

BURDEN OF LIVER DISEASE IN BRAZIL

BURDEN OF LIVER DISEASE IN BRAZIL BURDEN OF LIVER DISEASE IN BRAZIL Burden of Liver Disease in Europe Blachier et al. J Hepatol 58:593, 2013 Review of 260 epidemiologic studies of the 5 previous years Cirrhosis is responsible for 170.000

More information

Evaluation and Prognosis of Patients with Cirrhosis

Evaluation and Prognosis of Patients with Cirrhosis Evaluation and Prognosis of Patients with Cirrhosis Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded

More information

HEPATIC ENCEPHALOPATHY

HEPATIC ENCEPHALOPATHY HEPATIC ENCEPHALOPATHY Jan Albrecht Department of Neurotoxicology, Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland Brussels, July 14, 2009 DEFINITIONS: - HEPATIC ENCEPHALOPATHY (HE)

More information

Cirrhosis and HCV. Jonathan Israel M.D.

Cirrhosis and HCV. Jonathan Israel M.D. Cirrhosis and HCV Jonathan Israel M.D. Outline Relationship of fibrosis and cirrhosisprevalence and epidemiology. Sequelae of cirrhosis Diagnosis of cirrhosis Effect of cirrhosis on efficacy of treatment

More information

Research funding was provided by TAP Pharmaceutical Products, Inc.

Research funding was provided by TAP Pharmaceutical Products, Inc. DOES THE DOSING FREQUENCY OF PROTON PUMP INHIBITORS (PPIs) AFFECT SUBSEQUENT RESOURCE UTILIZATION AND COSTS AMONG PATIENTS DIAGNOSED WITH GASTROESOPHAGEAL REFLUX DISEASE (GERD)? Boulanger L 1, Mody R 2,

More information

ABSTRACT INTRODUCTION. Roxana Irimia 1, Carol Stanciu 2, Camelia Cojocariu 1,2, Cătălin Sfarti 1,2, Anca Trifan 1,2

ABSTRACT INTRODUCTION. Roxana Irimia 1, Carol Stanciu 2, Camelia Cojocariu 1,2, Cătălin Sfarti 1,2, Anca Trifan 1,2 Oral Glutamine Challenge Improves the Performance of Psychometric Tests for the Diagnosis of Minimal Hepatic Encephalopathy in Patients with Liver Cirrhosis Roxana Irimia 1, Carol Stanciu 2, Camelia Cojocariu

More information

Hepatic Encephalopathy Update: Prophylactic Therapy to Prevent Hepatic Encephalopathy

Hepatic Encephalopathy Update: Prophylactic Therapy to Prevent Hepatic Encephalopathy Update: Project ID: 12-0008-NL-2 Credit Designation Update: Purdue University College of Pharmacy designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should

More information

Study of Effects of Probiotic Lactobacilli in Preventing Major Complications in Patients of Liver Cirrhosis

Study of Effects of Probiotic Lactobacilli in Preventing Major Complications in Patients of Liver Cirrhosis Research Article Study of Effects of Probiotic Lactobacilli in Preventing Major Complications in Patients of Liver Cirrhosis RR. Pawar*, ML. Pardeshi and BB. Ghongane Department of Pharmacology, B.J. Medical

More information

National Health Burden of CLD in Italy

National Health Burden of CLD in Italy National Health Burden of CLD in Italy 11,000 deaths due to liver cirrhosis or HCC in 2006 Direct costs for the National Health System for treating CLD patients: 420 M / year for hospital care 164 M /

More information

Liver Diseases. An Essential Guide for Nurses and Health Care Professionals

Liver Diseases. An Essential Guide for Nurses and Health Care Professionals Brochure More information from http://www.researchandmarkets.com/reports/1047385/ Liver Diseases. An Essential Guide for Nurses and Health Care Professionals Description: Liver disease is a rapidly growing

More information

STATISTICAL BRIEF #8. Conditions Related to Uninsured Hospitalizations, 2003. Highlights. Introduction. Findings. May 2006

STATISTICAL BRIEF #8. Conditions Related to Uninsured Hospitalizations, 2003. Highlights. Introduction. Findings. May 2006 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #8 Agency for Healthcare Research and Quality May 2006 Conditions Related to Uninsured Hospitalizations, 2003 Anne Elixhauser, Ph.D. and C. Allison

More information

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Last update: February 23, 2015 Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Please see healthpartners.com for Medicare coverage criteria. Table of Contents 1. Harvoni 2. Sovaldi

More information

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Liver Transplantation for Hepatocellular Carcinoma John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Hepatocellular Carcinoma HCC is the 5th most common

More information

rifaximin 550mg film-coated tablets (Targaxan ) SMC No. (893/13) Norgine Pharmaceuticals Ltd

rifaximin 550mg film-coated tablets (Targaxan ) SMC No. (893/13) Norgine Pharmaceuticals Ltd rifaximin 550mg film-coated tablets (Targaxan ) SMC No. (893/13) Norgine Pharmaceuticals Ltd 09 August 2013 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and

More information

Lactulose for Minimal Hepatic Encephalopathy in Patients with Extrahepatic Portal Vein Obstruction

Lactulose for Minimal Hepatic Encephalopathy in Patients with Extrahepatic Portal Vein Obstruction Original Article Lactulose for Minimal Hepatic Encephalopathy in Patients with Extrahepatic Portal Vein Obstruction Praveen Sharma, Barjesh Chander Sharma Department of, G. B. Pant Hospital, New Delhi,

More information

Global Economic Impact of Multiple Sclerosis

Global Economic Impact of Multiple Sclerosis Global Economic Impact of Multiple Sclerosis May 2010 Literature Review Executive Summary Prepared for Multiple Sclerosis International Federation London, United Kingdom Prepared by Michael Trisolini,

More information

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH Professor of Medicine Department of Gastroenterology Director, Viral Hepatitis Center University of California San Francisco

More information

Hepatitis C Infections in Oregon September 2014

Hepatitis C Infections in Oregon September 2014 Public Health Division Hepatitis C Infections in Oregon September 214 Chronic HCV in Oregon Since 25, when positive laboratory results for HCV infection became reportable in Oregon, 47,252 persons with

More information

MANAGEMENT OF LIVER CIRRHOSIS

MANAGEMENT OF LIVER CIRRHOSIS MANAGEMENT OF LIVER CIRRHOSIS Information Leaflet Your Health. Our Priority. Page 2 of 6 What is cirrhosis? Cirrhosis is a result of long-term, continuous damage to the liver and may be due to many different

More information

Date of preparation: March 2015. GL/XIF/0214/0011a(1)

Date of preparation: March 2015. GL/XIF/0214/0011a(1) Date of preparation: March 2015. GL/XIF/0214/0011a(1) 1 This educational programme is funded by a grant from Norgine. Norgine has no involvement in the development of the content, which is developed independently

More information

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 MMWR August 17, 2012 Prepared by : The National Viral Hepatitis Technical Assistance Center

More information

Probiotic for the Treatment of Minimal Hepatic Encephalopathy: Preliminary Report ABSTRACT

Probiotic for the Treatment of Minimal Hepatic Encephalopathy: Preliminary Report ABSTRACT Original Article Issariyakulkarn N, et al. THAI J GASTROENTEROL 2010 Vol. 11 No. 3 Sept. - Dec. 2010 129 Issariyakulkarn N Sanpajit T Surangsrirat S ABSTRACT Objectives: Minimal hepatic encephalopathy

More information

STATISTICAL BRIEF #23

STATISTICAL BRIEF #23 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #23 Agency for Healthcare Research and Quality January 2007 Bariatric Surgery Utilization and Outcomes in 1998 and 2004 Yafu Zhao, M.S. and William

More information

HCUP Methods Series HCUP External Cause of Injury (E Code) Evaluation Report (2001 HCUP Data) Report # 2004-06

HCUP Methods Series HCUP External Cause of Injury (E Code) Evaluation Report (2001 HCUP Data) Report # 2004-06 HCUP Methods Series Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 http://www.hcup-us.ahrq.gov For Technical

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

BACKGROUND MEDIA INFORMATION Fast facts about liver disease

BACKGROUND MEDIA INFORMATION Fast facts about liver disease BACKGROUND MEDIA INFORMATION Fast facts about liver disease Liver, or hepatic, disease comprises a wide range of complex conditions that affect the liver. Liver diseases are extremely costly in terms of

More information

New All Oral Therapy for Chronic Hepatitis C Virus (HCV): A Cost-Benefit Analysis

New All Oral Therapy for Chronic Hepatitis C Virus (HCV): A Cost-Benefit Analysis New All Oral Therapy for Chronic Hepatitis C Virus (HCV): A Cost-Benefit Analysis Jennifer Orsi, MPH 4 th International Conference on Viral Hepatitis March 17, 2014 2014 Walgreen Co. All rights reserved.

More information

Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration

Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration O R I G I N A L A R T I C L E Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration MATTHEW L. MACIEJEWSKI, PHD 1,2 CHARLES MAYNARD, PHD 1,2 OBJECTIVE

More information

Hepatic Encephalopathy, Hyperammonemia, and Current Treatment in ICU Room

Hepatic Encephalopathy, Hyperammonemia, and Current Treatment in ICU Room Hepatic Encephalopathy, Hyperammonemia, and Current Treatment in ICU Room Assoc.Prof. Chan Sovandy Chairman by : Prof.So Saphy and Assoc Prof, Kim chhoung Hepatic Encephalopathy Hepatic (portal systemic

More information

Acute on Chronic Liver Failure: Current Concepts. Disclosures

Acute on Chronic Liver Failure: Current Concepts. Disclosures Acute on Chronic Liver Failure: Current Concepts Vandana Khungar, MD MSc Assistant Professor of Medicine University of Pennsylvania, Perelman School of Medicine September 20, 2015 None to declare Disclosures

More information

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT HARVONI (90mg ledipasvir/400mg sofosbuvir): tablet (PREFERRED AGENT) SOVALDI (sofosbuvir ): 400mg tablets (PREFERRED AGENT ) OLYSIO (simeprivir) PEG-INTRON

More information

Care Management Council submission date: August 2013. Contact Information

Care Management Council submission date: August 2013. Contact Information Clinical Practice Approval Form Clinical Practice Title: Acute use of Buprenorphine for the Treatment of Opioid Dependence and Detoxification Type of Review: New Clinical Practice Revisions of Existing

More information

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance Alcohol-use disorders: alcohol dependence Costing report Implementing NICE guidance February 2011 (February 2011) 1 of 37 NICE clinical guideline 115 This costing report accompanies the clinical guideline:

More information

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE The following diagnostic tests for Obstructive Sleep Apnea (OSA) should

More information

There may be up to 5 to 6 million cases of. Treatment Costs of Community- Acquired Pneumonia in an Employed Population*

There may be up to 5 to 6 million cases of. Treatment Costs of Community- Acquired Pneumonia in an Employed Population* Treatment Costs of Community- Acquired Pneumonia in an Employed Population* Gene L. Colice, MD, FCCP; Melissa A. Morley, MA; Carl Asche, PhD; and Howard G. Birnbaum, PhD Background: Community-acquired

More information

Prior Authorization Conditions for Approval of Hepatitis C Agents

Prior Authorization Conditions for Approval of Hepatitis C Agents Prior Authorization Conditions for Approval of Hepatitis C Agents All requests for Hepatitis C Agents require a prior authorization and will be screened for medical necessity and appropriateness using

More information

Medicare Risk-Adjustment & Correct Coding 101. Rev. 10_31_14. Provider Training

Medicare Risk-Adjustment & Correct Coding 101. Rev. 10_31_14. Provider Training Medicare Risk-Adjustment & Correct Coding 101 Rev. 10_31_14 Provider Training Objectives Medicare Advantage - Overview Risk Adjustment 101 Coding and Medical Record Documentation Requirements Medicare

More information

Alcohol Facts and Statistics

Alcohol Facts and Statistics Alcohol Facts and Statistics Alcohol Use in the United States: Prevalence of Drinking: In 2012, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime;

More information

HEPATOLOGY CLERKSHIP

HEPATOLOGY CLERKSHIP College of Osteopathic Medicine HEPATOLOGY CLERKSHIP Office for Clinical Affairs 515-271-1629 FAX 515-271-1727 Elective Rotation General Description This elective rotation is a four (4) week introductory,

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Core Benefit for Primary Care and Specialty Treatment and Prevention of Alcohol, Nicotine and Other Drug PREFACE Statement of the Problem:

More information

Certified Clinical Documentation Specialist Examination Content Outline - 2016

Certified Clinical Documentation Specialist Examination Content Outline - 2016 Certified Clinical Documentation Specialist Examination Content Outline - 2016 1. Healthcare Regulations, Reimbursement, and Documentation Requirements Related to the Inpatient Prospective Payment System

More information

CLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION

CLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION WHITE PAPER CLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION Technology to Help Your Physicians with the Transition to ICD-10 In the changing world of healthcare reform, let Nuance Healthcare

More information

ICD-9 Basics Study Guide

ICD-9 Basics Study Guide Board of Medical Specialty Coding ICD-9 Basics Study Guide for the Home Health ICD-9 Basic Competencies Examination Two Washingtonian Center 9737 Washingtonian Blvd., Ste. 100 Gaithersburg, MD 20878-7364

More information

DENOMINATOR: All patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis

DENOMINATOR: All patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis Measure #401: Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY

More information

Pediatric Gastroenterology Fellowship Pediatric Nutrition Rotation Goals and Objectives - 1 st Year

Pediatric Gastroenterology Fellowship Pediatric Nutrition Rotation Goals and Objectives - 1 st Year Pediatric Nutrition Rotation Goals and Objectives - 1 st Year Goal 1: Gain experience and competency in managing common and rare gastrointestinal, liver and nutritional problems. (Competencies: patient

More information

FACTORS ASSOCIATED WITH HEALTHCARE COSTS AMONG ELDERLY PATIENTS WITH DIABETIC NEUROPATHY

FACTORS ASSOCIATED WITH HEALTHCARE COSTS AMONG ELDERLY PATIENTS WITH DIABETIC NEUROPATHY FACTORS ASSOCIATED WITH HEALTHCARE COSTS AMONG ELDERLY PATIENTS WITH DIABETIC NEUROPATHY Luke Boulanger, MA, MBA 1, Yang Zhao, PhD 2, Yanjun Bao, PhD 1, Cassie Cai, MS, MSPH 1, Wenyu Ye, PhD 2, Mason W

More information

GASTROENTEROLOGY FELLOWSHIP HEPATOLOGY ROTATION GOALS AND OBJECTIVES University of Toledo

GASTROENTEROLOGY FELLOWSHIP HEPATOLOGY ROTATION GOALS AND OBJECTIVES University of Toledo GASTROENTEROLOGY FELLOWSHIP HEPATOLOGY ROTATION GOALS AND OBJECTIVES University of Toledo Educational Purpose: The Hepatology Rotation introduces the fellow to the management of outpatients and inpatients

More information

Living With Hepatic Encephalopathy (HE)

Living With Hepatic Encephalopathy (HE) Living With Hepatic Encephalopathy (HE) What is hepatic encephalopathy (HE)? HE is a condition that occurs in people with advanced cirrhosis or severe liver damage. The damaged liver cannot remove the

More information

3/25/2014. April 3, 2014. Dennison MM, et al. Ann Intern Med. 2014;160:293 300.

3/25/2014. April 3, 2014. Dennison MM, et al. Ann Intern Med. 2014;160:293 300. April 3, 2014 3.6 million persons ever infected; 2.7 million chronic infections 1 Up to 75% unaware of status Transmitted through percutaneous exposure to infected blood Injection drug use (IDU) is the

More information

1695 N.W. 9th Avenue, Suite 3302H Miami, FL. 33136. Days and Hours: Monday Friday 8:30a.m. 6:00p.m. (305) 355 9028 (JMH, Downtown)

1695 N.W. 9th Avenue, Suite 3302H Miami, FL. 33136. Days and Hours: Monday Friday 8:30a.m. 6:00p.m. (305) 355 9028 (JMH, Downtown) UNIVERSITY OF MIAMI, LEONARD M. MILLER SCHOOL OF MEDICINE CLINICAL NEUROPSYCHOLOGY UHEALTH PSYCHIATRY AT MENTAL HEALTH HOSPITAL CENTER 1695 N.W. 9th Avenue, Suite 3302H Miami, FL. 33136 Days and Hours:

More information

Reimbursement for Medical Products: Ensuring Marketplace

Reimbursement for Medical Products: Ensuring Marketplace Reimbursement for Medical Products: Ensuring Marketplace Success by Securing Coverage and Payment Christopher J. Panarites, Ph.D. Director, Endovascular Products Health Economics and Outcomes Research

More information

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion Angela Huskey, PharmD, CPE Case Bill is a 47 year old man with a history of low back pain and spinal stenosis Not a real

More information

Version History. Previous Versions. Drugs for MS.Drug facts box fingolimod Version 1.0 Author

Version History. Previous Versions. Drugs for MS.Drug facts box fingolimod Version 1.0 Author Version History Policy Title Drugs for MS.Drug facts box fingolimod Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review Date Supersedes/New (Further fields as required

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

PEER REVIEW HISTORY ARTICLE DETAILS VERSION 1 - REVIEW

PEER REVIEW HISTORY ARTICLE DETAILS VERSION 1 - REVIEW PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)

More information

Surveillance for Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

STATISTICAL BRIEF #92

STATISTICAL BRIEF #92 From July 2010 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #92 Agency for Healthcare Research and Quality Mental Health and Substance Abuse-Related Emergency Department Visits among Adults,

More information

Does referral from an emergency department to an. alcohol treatment center reduce subsequent. emergency room visits in patients with alcohol

Does referral from an emergency department to an. alcohol treatment center reduce subsequent. emergency room visits in patients with alcohol Does referral from an emergency department to an alcohol treatment center reduce subsequent emergency room visits in patients with alcohol intoxication? Robert Sapien, MD Department of Emergency Medicine

More information

Not All Clinical Trials Are Created Equal Understanding the Different Phases

Not All Clinical Trials Are Created Equal Understanding the Different Phases Not All Clinical Trials Are Created Equal Understanding the Different Phases This chapter will help you understand the differences between the various clinical trial phases and how these differences impact

More information

Over 50% of hospitalized patients are malnourished. Coding for Malnutrition in the Adult Patient: What the Physician Needs to Know

Over 50% of hospitalized patients are malnourished. Coding for Malnutrition in the Adult Patient: What the Physician Needs to Know Carol Rees Parrish, M.S., R.D., Series Editor Coding for Malnutrition in the Adult Patient: What the Physician Needs to Know Wendy Phillips At least half of all hospitalized patients are malnourished,

More information

Precipitating Factors of Hepatic Encephalopathy

Precipitating Factors of Hepatic Encephalopathy Original Article Precipitating Factors of Hepatic Encephalopathy Mohammad Tariq,* Saleem Iqbal,** Naji ullah Khan,* Rabia Basri*** From Department of Medicine, Khyber Teaching Hospital, Peshawar. *Post

More information

Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs

Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs T H E F A C T S A B O U T Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs Upstate New York Adults with diagnosed diabetes: 2003: 295,399 2008: 377,280 diagnosed

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement On Drug Testing as a Component of Addiction Treatment and Monitoring Programs and in other Clinical Settings [Note: ASAM also has a Public

More information

STATISTICAL BRIEF #49

STATISTICAL BRIEF #49 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #49 Agency for Healthcare Research and Quality April 2008 Hospital Stays Related to Child Maltreatment, 2005 C. Allison Russo, M.P.H., Megan M.

More information

Testimony of. Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment

Testimony of. Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment Testimony of Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment New York City Department of Health and Mental Hygiene before the New York City

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI)

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) The American Society for Gastrointestinal Endoscopy PIVI on Endoscopic Bariatric Procedures (short form) Please see related White

More information

STATISTICAL BRIEF #160

STATISTICAL BRIEF #160 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #160 Agency for Healthcare Research and Quality August 2013 National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011 Celeste

More information

STATISTICAL BRIEF #39

STATISTICAL BRIEF #39 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #39 Agency for Healthcare Research and Quality October 2007 Hospitalizations Related to Drug Abuse, 2005 Cheryl A. Kassed, Ph.D., Katharine R.

More information

Raising Sleep Apnea Awareness:

Raising Sleep Apnea Awareness: Raising Sleep Apnea Awareness: Among People with Diabetes in North Carolina, 2012 People with diabetes have more sleep problems than people without diabetes in the same age, sex, and race/ethnicity group.

More information

Snoring and Obstructive Sleep Apnea (updated 09/06)

Snoring and Obstructive Sleep Apnea (updated 09/06) Snoring and Obstructive Sleep Apnea (updated 09/06) 1. Define: apnea, hypopnea, RDI, obstructive sleep apnea, central sleep apnea and upper airway resistance syndrome. BG 2. What are the criteria for mild,

More information

STATISTICAL BRIEF #168

STATISTICAL BRIEF #168 HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #168 Agency for Healthcare Research and Quality December 2013 Costs for Hospital Stays in the United States, 2011 Anne Pfuntner, Lauren M. Wier,

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Parity in Benefit Coverage: A Joint Statement by ASAM and AMBHA The American Managed Behavioral Healthcare Association (AMBHA) and the

More information

Coding with. Snayhil Rana

Coding with. Snayhil Rana Coding with ICD-9-CM CM Snayhil Rana ICD-9-CM CM Index Pre-Test Introduction to ICD-9-CM Coding The Three Volumes of the ICD-9-CM ICD-9-CM Coding Conventions Other ICD-9-CM Sections ICD-9-CM for Claim

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors

More information

Hepatitis C. Eliot Godofsky, MD University Hepatitis Center Bradenton, FL

Hepatitis C. Eliot Godofsky, MD University Hepatitis Center Bradenton, FL Hepatitis C Eliot Godofsky, MD University Hepatitis Center Bradenton, FL Recent Advances in Hepatitis C Appreciation that many patients are undiagnosed Improved screening to identify infected persons Assessment

More information

TECHNICAL/CLINICAL TOOLS BEST PRACTICE 7: Depression Screening and Management

TECHNICAL/CLINICAL TOOLS BEST PRACTICE 7: Depression Screening and Management TECHNICAL/CLINICAL TOOLS BEST PRACTICE 7: Depression Screening and Management WHY IS THIS IMPORTANT? Depression causes fluctuations in mood, low self esteem and loss of interest or pleasure in normally

More information

Alcoholic Hepatitis (Teacher s Guide)

Alcoholic Hepatitis (Teacher s Guide) Thomas Ormiston, M.D. Updated 5/5/15 2007-2015, SCVMC Alcoholic Hepatitis (Teacher s Guide) (30 minutes) I. Objectives Recognize the signs and symptoms of alcoholic hepatitis Understand the treatment options

More information

A prospective study on drug utilization pattern of anti-diabetic drugs in rural areas of Islampur, India

A prospective study on drug utilization pattern of anti-diabetic drugs in rural areas of Islampur, India Available online at www.scholarsresearchlibrary.com Scholars Research Library Der Pharmacia Lettre, 2015, 7 (5):33-37 (http://scholarsresearchlibrary.com/archive.html) ISSN 0975-5071 USA CODEN: DPLEB4

More information

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References)

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References) CARDIAC The delivery of Cardiac Rehab is unlike most other rehab populations. The vast majority of patients receive their rehab in outpatient or community settings and only a small subset requires an inpatient

More information

COMPLICATIONS OF CIRRHOSIS COMPLICATIONS OF CIRRHOSIS OBSERVATIONS OF AN AGING HEPATOLOGIST. Philip C. Delich, M.D.

COMPLICATIONS OF CIRRHOSIS COMPLICATIONS OF CIRRHOSIS OBSERVATIONS OF AN AGING HEPATOLOGIST. Philip C. Delich, M.D. 1 COMPLICATIONS OF CIRRHOSIS OBSERVATIONS OF AN AGING HEPATOLOGIST COMPLICATIONS OF CIRRHOSIS Philip C. Delich, M.D. Faculty Disclosure Dr. Delich has indicated that he does not have any relevant financial

More information

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Prepared by Ovation Research Group for the National Library of Medicine

More information

Clinical Medical Policy Cognitive Rehabilitation

Clinical Medical Policy Cognitive Rehabilitation Benefit Coverage Outpatient cognitive rehabilitation is considered to be the most appropriate setting for members who have sustained a traumatic brain injury or an acute brain insult. Covered Benefit for

More information

THE A, B, C S OF HEPATITIS. Matt Eidem, M.D. Digestive Health Associates of Texas 1600 Coit Road Suite #301 Plano, Texas 75075 (972) 867-0019

THE A, B, C S OF HEPATITIS. Matt Eidem, M.D. Digestive Health Associates of Texas 1600 Coit Road Suite #301 Plano, Texas 75075 (972) 867-0019 THE A, B, C S OF HEPATITIS Matt Eidem, M.D. Digestive Health Associates of Texas 1600 Coit Road Suite #301 Plano, Texas 75075 (972) 867-0019 WHAT IS HEPATITIS? Hepatitis means inflammation of the liver

More information

Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures

Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Table 1: Surgeon Billing for Laparoscopic Adjustable Gastric Band Procedures 2012 Medicare Payment 2 43770

More information

All Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions

All Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions All Patient Refined DRGs (APR-DRGs) An Overview Presented by Treo Solutions Presentation Highlights History of inpatient classification systems APR-DRGs: what they are, how they work, and why they are

More information

Increase Hepatitis C Virus Screening and Treatment

Increase Hepatitis C Virus Screening and Treatment 18 Increase Hepatitis C Virus Screening and Treatment Situation The number of deaths from liver cancer in Japan has been rising rapidly since 1975, and now stands at more than 30,000 per year. About 80

More information

An Overview of NYS Hepatitis C Testing Law. Statewide Stakeholder Meetings

An Overview of NYS Hepatitis C Testing Law. Statewide Stakeholder Meetings An Overview of NYS Hepatitis C Testing Law Statewide Stakeholder Meetings Agenda Overview of Hepatitis C virus (HCV) CDC HCV screening recommendations Review of HCV screening and diagnostic tests CDC HCV

More information

How do you decide on rate versus rhythm control?

How do you decide on rate versus rhythm control? How do you decide on rate versus rhythm control? Dr. Mark O Neill Consultant Cardiologist & Electrophysiologist Assumptions Camm et al. EHJ 2010;Sept 25 epub Choice of strategy: Criteria for consideration

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain

HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain Yes, still too many Measures to eradicate an Infectious Disease Prevention: Vaccination Screening

More information