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The recent approval of sofosbuvir plus ledipasvir, the first oral combination therapy for hepatitis C virus (HCV) treatment, has enabled many patients who were unable to tolerate previous therapies to become eligible for HCV treatment. However, this therapy is very expensive. The authors evaluated the cost-effectiveness and budget impact of sofosbuvir-ledipasvir. They concluded that the treatment is cost-effective in most patients with HCV, but additional resources and value-based patient prioritization will be needed to manage such patients.

Topics: cost effectiveness, hepatitis c, hepatitis c virus, sofosbuvir, ledipasvir, budgets
  
Mehdi Najafzadeh, PhD; Karin Andersson, MD; William H. Shrank, MD, MSHS; Alexis A. Krumme, MS; Olga S. Matlin, PhD; Troyen Brennan, MD, JD, MPH; Jerry Avorn, MD; and Niteesh K. Choudhry, MD, PhD

Treating HCV with newer regimens seems efficacious but expensive. The authors analyzed the cost-effectiveness of standard regimens versus newer regimens containing sofosbuvir for each HCV genotype and found that newer regimens were cost-effective for genotype 1 and probably genotype 3 but not genotype 2. Reducing the prices of newer HCV drugs may not only be cost-effective but may also reduce the cost of HCV treatment over time.

Topics: cost effectiveness, genotype, quality-adjusted life years, ribavirin, hepatitis c virus, sensitivity analysis, ...
  

Tuberculosis (TB) screening of immigrants and refugees bound for the United States has been based on a smear-based screening algorithm. This cross-sectional study evaluated the effect of a culture-based algorithm, introduced in 2007, on preventing importation of TB to the United States. The culture-based algorithm increased the number of TB cases detected in immigrants and refugees. The authors conclude that screening strategies should be expanded to reduce the number of new TB cases in the United States.

Topics: refugees, tuberculosis, immigrants
  
Jetan H. Badhiwala, MD; Chung K. Lai, BHSc; Waleed Alhazzani, MD; Forough Farrokhyar, PhD; Farshad Nassiri, MD; Maureen Meade, MD; Alireza Mansouri, MD; Niv Sne, MD; Mohammed Aref, MD; Naresh Murty, MD; Christopher Witiw, MD; Sheila Singh, MD, PhD; Blake Yarascavitch, MD; Kesava Reddy, MD; and Saleh A. Almenawer, MD

Protocols for cervical spine clearance are controversial for unconscious patients after blunt traumatic injury and negative computed tomography findings. The potential emotional, psychological, and social burdens faced by these patients can lead physicians to prolong collar use as a defensive measure rather than one based on medical necessity. This systematic review found that cervical spine clearance in obtunded adults after blunt traumatic injury with negative computed tomography results is probably safe and efficient.

Topics: magnetic resonance imaging, computed tomography, wounds and injuries, stupor, cervical collar, cervical ...
  

In this article, the High Value Care Task Force of the American College of Physicians recommends against the use of resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging to screen for cardiac disease in asymptomatic, low-risk adults. The Task Force recommends that clinicians instead focus on strategies for mitigating cardiovascular risk by treating modifiable risk factors and encouraging healthy levels of exercise.

Topics: stress echocardiography, heart function tests, heart, electrocardiogram, myocardial perfusion imaging, american college ...
  

Type 2 myocardial infarction, defined as infarction occurring in the absence of acute coronary syndromes from an imbalance between myocardial oxygen supply and demand, is evolving into a distinct clinical entity but lacks a separate diagnostic code. This commentary discusses the clinical, epidemiologic, and economic ramifications from the lack of a diagnostic code for type 2 myocardial infarction.

Topics: myocardial infarction, acute
  

Some argue that changes in the U.S. Department of Health and Human Services and the U.S. Public Health Service have diminished the power of the U.S. Surgeon General over the years. In this commentary, former Surgeon General David Satcher contends that the Office of the Surgeon General has actually gained credibility and influence with the American people as the reporting structure has evolved.

Topics: health policy, united states dept. of health and human services, united states ...
  

Tuberculosis is the topic of this issue's discussion from the Annals archives.

Topics: american college of physicians
  
Kirstin Hirni, MD; and Brian Carter, MD
Includes: Audio/Video

The monitor beeped on in the otherwise silent room. Eventually, I cleared my throat, mindful of my agenda. "Grandma, have you thought about what you want to do if you are dying?"

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Jordanna M. Hostler, MD; David C. Hostler, MD, MPH; and Aaron B. Holley, MD
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Paul Shekelle, MD, PhD; Jon-Erik C. Holty, MD, MS; Thomas D. Denberg, MD, PhD; and Amir Qaseem, MD, PhD, MHA
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Michael E. O'Callaghan, BSc(Hons), PhD; Ganessan Kichenadasse, MBBS; Sina Vatandoust, MD; and Kim Moretti, MBBS
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Neeral L. Shah, MD; Virginia Kelly, RN; and Stephen H. Caldwell, MD
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Shyam Kottilil, MD, PhD; Mary Wright, MD, MPH; Michael A. Polis, MD, MPH; and Henry Masur, MD
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Laura S. Welch, MD; David Madtes, MD; and Knut Ringen, DrPH
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Yi Tang, MD, PhD; Xiangbo Wang, MD; and Jianping Jia, MD, PhD
Topics: creutzfeldt-jakob disease, mercury poisoning
  
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Bhuvana Chandra, MD
Includes: Audio/Video
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Brenda Butka, MD
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Topics: heart
  
Topics: myocardial infarction, reperfusion therapy, mortality
  
Topics: septic shock, mortality, goal-directed therapy, follow-up
  
Topics: chronic obstructive airway disease, inhaled glucocorticoids, follow-up
  
Topics: hyperglycemia, glucocorticoids, treatment failure, obstructive airways disease, chronic, exacerbation, acute
  
Topics: glucocorticoids, obstructive airways disease, chronic, exacerbation, acute
  
Topics: percutaneous coronary intervention, coronary artery bypass surgery, diabetes mellitus, cerebrovascular accident, left ...
  
Topics: drug-eluting stents, stent thrombosis, follow-up
  
Topics: benign positional vertigo, epley maneuver
  
Topics: follow-up, rotator cuff injury, tendon repair
  
Topics: ulcerative colitis, skin carcinoma, thiopurine
  
Topics: dalteparin, critical illness, venous thromboembolism
  

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: anticoagulation, consultation
  
Topics: electrocardiogram, stress echocardiography, heart, myocardial perfusion imaging, screening test
  
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