A step closer to precision treatments for chronic liver disease

Chronic hepatitis C (CHC), a long-term illness that can lead to serious liver problems, affects an estimated 2.7-3.9 million people in the U.S. Several recently approved medications offer highly effective, potentially life-saving treatment for CHC with fewer side effects than previously available options, prompting an increase in demand for these drugs.  

But these new medications are costly, and not always immediately available. And rapid treatment does not benefit all CHC patients equally. How can healthcare providers determine which individuals would gain the most from immediate therapy in a way that also considers questions of access and resource use?

New research led by Akbar Waljee, M.D., M.Sc., an assistant professor of internal medicine in the U-M Medical School and a research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System, will develop a risk-based strategy to help providers tailor timing of treatments among CHC Veterans to ensure that those who most need urgent therapy get it as quickly as possible.

Veterans have higher rates of CHC than the general population, and approximately 250,000 U.S. Veterans live with the illness.

Under a new VA Merit Review grant, Waljee and team will develop advanced prediction models for disease progression based on real-world data from the VHA electronic health record to accurately identify those who would most benefit from early CHC therapy.

The study will also engage Veterans to gauge their thoughts and preferences about such a strategy, which will help with its implementation in a clinical setting.

This research will also evaluate the projected economic impact of the new targeted treatment models as well as their potential effects on access to care. This work could also inform future efforts to implement risk-based management strategies across other conditions in other clinical contexts.