Harvoni Case Study

denied by Humana. This was our first attempt to purchase this medication since our group (HM

The review of the appeal request for denial of an acute inpatient stay, date of service on December 19, 2016 to December 22, 2016, based on medical necessity, has been completed by Oneka Pratt, PA-C under the oversight of Dr. Teresa Homan.

The exam may show stunted or failure to grow, intense low blood sugar, enlarged liver gout, inflammatory bowel disease,

However, it was difficult to achieve a remission, standard haemoglobin without haemolysis, despite following the steroid therapy. At her three months check-up, she complained of mild shortness of breath and fatigue of ten days duration. She was receiving prednisolone 10 mg daily along with folic acid. Examination revealed mild pallor and a palpable spleen. Laboratory workup showed low Hb (11.8 g/l); Reticulocyte count had slightly risen (2.7%) and PBF showed polychromatic and few spherocytes. Her direct Coomb's test was still strongly positive. Serum biochemistry revealed normal indirect bilirubin and a raised LDH (295 u/l). B12 and folate levels were normal. Consequently, due to signs of some improvement, the steroids were initially maintained but gradually reduced to 5mg every other day. After about six months of steroid therapy and folate, the haemoglobin became standard. Currently, she is in remission with no

The equipment is composed of a probe, an in-built ultrasound system and an electronic unit for data processing. Through a transductor, low amplitude vibrations produced by the probe are transmitted to liver tissue. Simultaneously, the ultrasound system generates pulses that track and determine the rapidity of propagation of elastic waves within the parenchyma. The velocity of propagation is directly related to elasticity: the harder the tissue, the faster the propagation of elastic waves. Hence, tests with high results generally indicate the presence of significant fibrosis in liver parenchyma. The final result is the median of all valid acquisitions, which is considered to be representative of the hepatic elasticity, expressed in kilopascals (kPa), within a range of 2.5-75.0 kPa. The test is simple, fast (usually performed in less than 5 min), and can be easily carried out in both inpatient and outpatient settings. Neither special preparation nor laboratory tests are

Initial liver biopsy is recommended for assessment of the inflammatory activity and the severity of fibrosis, which is useful for making therapeutic decision. The work-up shows that interface and zone 1 lobular hepatitis is the hallmark with the characteristic lymphoplasmacytic infiltrate, typically prominent portal and periportal (in case of bridging necrosis or cirrhosis) inflammation which generally spares the bile ducts, and acinar transformation of hepatocytes (rosettes formation). Plasma cells may not be dominant but prominent inflammatory cells only at the interface. The non-specificity of histological findings to autoimmune hepatitis should always be remembered, and the absence of plasma cells does not preclude the diagnosis. Meanwhile,

Define the stage of the disease is very important for diagnosis, treatment, and follow-up . There are many ways for assessing the degree of liver fibrosis. Liver biopsy was the gold standard for assessing liver fibrosis, but now it is of limited value because it is so invasive, its high cost, poor acceptance, risk of complications, and intra/inter-observer variability (Poynard et al.,2007). During the different stages of fibrosis , there are excessive amounts of extracellular matrix of various biomarkers changed and new biomarkers appeared in the serum (Jarcuska et al.,2010 and Baranova et al. 2011).

Nurse did not update on the ordered test. Test ordered was very broad and non-specific test. ARUP (reference call # 4121711) suggested HLA goes up to 42 different tests and needed specific panel. They suggested 3 major panels 2011264,

Hepatitis B is the most common liver infection in the world. Worldwide, about 350 million people are chronic carriers of HBV (Hepatitis B Virus), among these carriers, more than 620,000 die from liver-related diseases each year. In the United States, hepatitis B mainly affects adults aged between 20-50 years. About 800,000 to 1.4 million Americans are chronic hepatitis B virus carriers, and the disease causes about 3,000 deaths each year. The good news is that infection with HBV is usually preventable because there is an effective vaccine. Use of the vaccine has resulted in an 82% decrease in the number of new infections reported in the United

checked if you are within the risk fasts or have a family history of it. There are only three tests

Hepatitis C is a significant public health problem in Australia with approximately 10000 new infections occurring annually1. In 25% of patients, acute Hepatitis C infection is followed by viral clearance, defined as undetectable levels of HCV RNA in the blood, with the remaining 75% progressing to chronic infection. Without intervention, those with chronic infection are at increased risk of hepatic fibrosis and progression to hepatic cirrhosis. There appears to be a significant variation in the reported rates of progression of chronic hepatitis C infection to cirrhosis, ranging from 4% to 20% in 20 years, depending on the sample population and method of acquisition of the virus2. The risk of development of hepatocellular cancer is about 2 – 4% per annum3. Current use of alcohol7, type 2 diabetes and those with the metabolic syndrome are more likely to progress to cirrhosis when infection with hepatitis C is present.

Traditionally, HCV screenings was offered to those considered at high risk, however; the rationale behind doing testing for hepatitis C among baby boomers is because they are 5 times more likely to have hepatitis C than the general population. Nowadays, the regimen therapy for hepatitis C infection is much less toxic than prior antivirals (i.e. interferon B, ribavirin), and the cure rates are more than 95% with current therapy. Additionally, hepatitis C chronic infection may cause significant morbidity (liver cirrhosis) and increase health care costs when patients develop the complications from cirrhosis.

“There are two stages of hepatitis C. The acute (early) phase occurs soon after infection. Most people have no symptoms at this stage. Roughly 50% - 80% of individuals infected go on to develop a chronic infection.”(Bhupinder,para.3) As of now, there might be no indications for a considerable length of time. In the end, if left untreated, many people with incessant hepatitis C will end up noticeably symptomatic with liver cancer.

A main obstacle to treatment is the cost of diagnostics and drugs. Prioritization policies have been suggested to augment the influence of DAA on decreasing the burden of disease in several settings 41. One method is to prioritize those with advanced stage of liver disease to improve in the patient's life quality and survival 42.