الفهرس 
The HCV Entry ProcessOnly 14 pages are availabe for public view
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Abstract
Hepatitis C virus (HCV) infection remains a major health problem,
with approximately 200 million individuals is affected worldwide
(Sebastiani G et al., 2006). Egypt reports the highest prevalence of HCV
worldwide, ranging from 6% to more than 40% among regions and
demographic with an average of 13.8% (Abdel‐Aziz F et al., 2000, El‐
Sadawy M et al., 2004, Lehman EM and Wilson ML, 2009).
The prognosis and management of chronic HCV greatly depends
on the degree and progression of liver fibrosis. Until recently, liver
biopsy was the only way to evaluate fibrosis in the liver (Bravo AA et al.,
2001)
However, liver biopsy is an invasive and painful procedure
(Castera L et al., 1999; Cadranel JF et al., 2000) with rare but potentially
life‐threatening complications (Bravo AA et al., 2001).
In 2003, Wai et al; derived and validated the aspartate
aminotransferase‐to‐platelet ratio index (APRI) calculated as aspartate
aminotransferase (AST) (U/L)/upper normal x100/platelet count (103/L)]
(Wai C.T et al., 2003).
The aim of this study is to evaluate the importance and cost
effectiveness of the pre‐treatment liver biopsy in the management of
chronic HCV patients. Also to study the accuracy of AST Platelets ratio
index as a non‐invasive alternative for determining stage of liver fibrosis
needed for treatment decision in chronic HCV patients
SUMMARY AND
CONCLUSION
The study was carried out at the Hepatology Department,
National Liver Institute, Menoufiya University, Egypt. One thousand
patients with chronic hepatitis C (CHC) infection, who were referred for
liver biopsy prior to antiviral therapy, were recruited.
The effectiveness of liver biopsy was compared with the
effectiveness of APRI score by determining the reduction in number of
patients treated with Peg interferon plus ribaverin from using this
strategy. The cost effectiveness ratio was calculated by dividing the
incremental (marginal) costs in Egyptian pounds (net costs from
performed liver biopsy with APRIscore) by the incremental
effectiveness (measured as number of patients prevented) between
the two strategies. This ratio is expressed as the Incremental cost to
prevent treatment of one patient.
In our model, total cost per patient according to liver biopsy
(procedure, complications and course of 48 wk Peg interferon plus
ribaverin of indicated patients was 17967 LE and total cost per patient
according to APRI score indicated patients was 25515 LE at cut‐off (0.48)
and 18554 LE at cut‐off (0.6) respectively. The difference between the
two strategies, or the incremental cost per patient, was 7548 LE at cutoff
(0.48 and 587 LE at cut‐off (0.6). This result is extremely sensitive to
the cost estimate of the procedures. The incremental cost per patient,
which depends on the additional cost of treated patients according to
APRI score, is a better measure, as it does not depend on the cost
estimate of the procedure. The marginal effectiveness in our analysis,
expressed as the number of treated patients prevented by using of liver
biopsy was 149 patients at cut‐off (0.48) and 16 patients at cut‐off (0.6)
per 1000 liver biopsies. The incremental (marginal) cost of treated
patient prevented by using of liver biopsy was 50658 LE at cut‐off (0.48),
36699 LE at cut‐off (0.6).
In conclusion, we have shown that APRI could identify significant
fibrosis and cirrhosis at a high degree of accuracy in studied patients
compared with liver biopsy. Significant fibrosis could be classified
correctly according to liver biopsy in 62% and advanced fibrosis in 78%
of patients the APRI has moderate diagnostic utility for the prediction of
fibrosis in HCV-infected patients. Its major role appears to be the
exclusion of significant fibrosis and cirrhosis.
The of liver biopsy have a cost effectiveness ratio compared with
the effectiveness of APRI score by determining the reduction in number
of patients treated with Peg interferon plus ribaverin from using this
strategy. The marginal effectiveness in our analysis, expressed as the
number of treated patients prevented by using of liver biopsy was 149
patients at cut‐off (0.48) and 16 patients at cut‐off (0.6) per 1000 liver
biopsies. The incremental (marginal) cost of treated patient prevented
by using of liver biopsy was 50658 LE at cut‐off (0.48), 36699 LE at cutoff
(0.6).