Publications by authors named "Faleh Z Alfaleh"

7 Publications

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A tool to measure the economic impact of Hepatitis B elimination: A case study in Saudi Arabia.

J Infect Public Health 2020 Nov 26;13(11):1715-1723. Epub 2020 Sep 26.

Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: No virologic cure exists for hepatitis B virus (HBV) infection, and existing therapies are designed to control viral replication. We aimed to estimate the national prevalence of HBsAg in 2017 and study the impact of an enhanced diagnosis rate and universal treatment administration on HBV-related outcomes in Saudi Arabia.

Materials And Methods: A dynamic transmission and disease burden model was developed to estimate the future economic burden of HBV infection. The infected population was tracked by age and gender-defined cohorts; direct costs (healthcare, screening, diagnostics and treatment) and indirect costs (disability-adjusted life years and the value of a statistical life year) were calculated. The impact of two intervention scenarios (Achieve WHO Targets: diagnose 90% of infections and treat 80% of high viral load patients by 2030; and Diagnose and Treat All: diagnose and treat all infected patients by 2022) were compared against the Base Case scenario (no policy action), with near-universal vaccination coverage rates held constant. A sensitivity analysis of future treatment cost was also conducted.

Results: In 2017, HBsAg prevalence was estimated at 1.7%, corresponding to 574,000 infections. The same year, there was an estimated incidence of 490 cases of decompensated cirrhosis, 1500 cases of hepatocellular carcinoma (HCC) and 1740 liver-related deaths (LRD). HBsAg prevalence was 0.1% among 5-year-olds and <0.1% among infants. Disease burden outcomes by 2030, as compared with 2015, were as follows - Base Case: LRDs and HCC incidence were projected to increase by 70%. WHO Targets: A 30-35% decline in both HCC incidence and LRDs. Diagnose and Treat All: A 50-55% decline in HCC incidence and LRDs. In all scenarios, HBsAg prevalence among infants and 5-year-olds declined to <0.1% with the Diagnose and Treat all scenario resulting in a prevalence approaching zero in this age group. Annual direct costs are projected to increase and peak by 2022 in both intervention scenarios due to expansion of treatment and diagnostics. However, these are offset by the reduction of indirect economic costs, starting immediately in the WHO Targets scenario and by 2023 in the strategy to diagnose and treat all. Achieving WHO Targets is estimated to achieve a positive return on investment (ROI) by 2021 when examining direct costs and indirect economic losses at a treatment price of $2700 USD per patient yearly. Diagnosing and treating all patients, however, would require at least a 50% reduction in the unit cost of treatment to achieve a positive ROI by 2029.

Conclusions: Increased diagnosis and treatment rates of HBV would lead to substantial declines in HCC and LRD. This effect would be dramatically enhanced by administering treatment to all HBV cases regardless of viral load and estimated to be highly cost-effective if treatment prices can be substantially reduced.
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http://dx.doi.org/10.1016/j.jiph.2020.09.004DOI Listing
November 2020

Greater prevalence of comorbidities with increasing age: Cross-sectional analysis of chronic hepatitis B patients in Saudi Arabia.

Saudi J Gastroenterol 2019 May-Jun;25(3):194-200

Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia.

Background/aims: Middle Eastern countries, including Saudi Arabia to some extent, are endemic for chronic hepatitis B (CHB) infection which could be associated with high mortality and comorbidities risk. However, limited data characterizing this CHB population exists. Our aim was to characterize and compare CHB patients in 2015 with those in 2010 and 2012 in Saudi Arabia.

Patients And Methods: We conducted and compared three cross-sectional analyses of adult patients with CHB defined as either positive hepatitis B surface antigen or documented CHB history in 2010, 2012, and 2015. Data were accessed from the multicenter Systematic Observatory Liver Disease Registry (SOLID).

Results: A total of 765 CHB patients were identified in 2010 (n = 274), 2012 (n = 256), and 2015 (n = 235). Median age was significantly higher in 2015 (47 years) compared to 2010 and 2012 (42 years;P < 0.05). The proportions of patients with hepatocellular carcinoma (range 1-12%) and cirrhosis (range 5-23%) were significantly higher in 2015 compared to 2010 and 2012 (P < 0.05). Compared to 2010, patients in 2015 had significantly (P < 0.05) higher prevalence of coronary artery disease (10% vs. 4%) and hyperbilirubinemia (18% vs. 9%). Although not significant, there was a numerical increase in 2015 in chronic kidney disease (9% vs. 7% in 2010;P= 0.559) and hepatic steatosis (32% vs. 25% in 2010;P= 0.074). Significantly more patients in 2015 (P < 0.05) were treatment experienced (23% vs. 5% in 2010/2012) and switched treatment (17% vs. 1-2% in 2010/2012).

Conclusions: Between 2010 and 2015, the CHB population in Saudi Arabia had significantly aged and was more likely to develop liver disease sequelae and other comorbidities.
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http://dx.doi.org/10.4103/sjg.SJG_447_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526730PMC
April 2020

SASLT position statement on the direct-acting antiviral agents for the treatment of hepatitis C virus infection.

Saudi J Gastroenterol 2015 Mar-Apr;21(2):60-3

Division of Gastroenterology, Department of Medicine, King Abdulaziz Medical City, Jeddah; Liver Disease Research Center, Riyadh, Saudi Arabia.

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http://dx.doi.org/10.4103/1319-3767.153810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392576PMC
January 2016

Predictors of significant fibrosis in chronic hepatitis B patients with low viremia.

J Clin Gastroenterol 2014 Jul;48(6):e50-6

*College of Medicine, Liver Disease Research Center, King Saud University †Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, AB, Canada ‡Department of Gastroenterology, Riyadh Military Hospital, Riyadh §Department of Medicine, Division of Gastroenterology, King Fahad General Hospital, Jeddah ∥Department of Medicine, Division of Gastroenterology ¶Department of Pathology, King Faisal Specialist Hospital & Research Center Departments of #Pathology **Hepatobiliary Sciences & Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background And Aim: The data on the prevalence and predictors of significant fibrosis (≥F2, METAVIR) in chronic hepatitis B virus (HBV) patients with low viremia are limited. We aimed to assess both the prevalence predictors of ≥F2 fibrosis in hepatitis B envelope antigen-negative patients with HBV DNA <20,000 IU/mL.

Methods: Hepatitis B envelope antigen-negative patients (n=213) with mean HBV DNA <2000 IU/mL (n=97) and HBV DNA 2000 to 20,000 IU/mL (n=116) were included and all had liver biopsy. Variables significantly associated with ≥F2 fibrosis on an univariate analysis were included in a multivariate logistic regression model.

Results: Overall, 40 (18.8%) patients had ≥F2 fibrosis, with no difference between those with mean HBV DNA <2000 IU/mL (19.6%) compared with patients with HBV DNA of 2000 to 20,000 IU/mL (18.1%; P=0.782). Fibrosis ≥F2 was similar in patients with HBV DNA <2000 versus 2000 to 20,000 IU/mL in relation to varying alanine aminotransferase thresholds (P>0.05), and was less frequent in persistently normal alanine aminotransferase patients (13.6%) when compared with those with elevated or fluctuating levels (25.3%, P=0.030). Fewer patients under 40 years of age had ≥F2 fibrosis (12.5%) as compared with older ones (28.2%; P=0.004). Logistic regression analysis identified higher aspartate aminotransferase [odds ratio (OR), 6.21; 95% confidence interval (CI), 2.48-15.54; P<0.0001], lower albumin (OR, 0.86; 95% CI, 0.78-0.95; P=0.002), platelet count (OR, 0.99; 95% CI, 0.98-0.99; P=0.013), and age (OR, 1.05; 95% CI, 1.01-1.09; P=0.024) as independent predictors of significant fibrosis.

Conclusions: A small but significant minority of HBV patients with low viremia harbor significant fibrosis, although its rate is not different in those with viremia above or below 2000 IU/mL. Our findings may guide in decisions regarding liver biopsy and treatment in this category of patients.
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http://dx.doi.org/10.1097/MCG.0b013e3182a9a2e1DOI Listing
July 2014

The natural history and long-term outcomes in patients with chronic hepatitis C genotype 4 after interferon-based therapy.

Liver Int 2013 Jul 15;33(6):871-83. Epub 2013 Mar 15.

Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background & Aims: Hepatitis C virus (HCV) genotype 4 (G4) infection is common in the Middle East. Post-treatment long-term outcomes have not been reported in these patients. This study evaluates these outcomes in patients after interferon-based therapy.

Patients And Methods: A total of 157 patients were followed from June 2001 to February 2012. Descriptive and analytical statistics, cumulative outcomes and the independent predictors of disease progression were calculated.

Results: The overall age was 48.0 ± 11.8 years, 75 (47.8%) were males and 53 (70.7%) of 75 who were genotyped had G4. The follow-up period was 63.8 ± 32.8 months. Sustained virological response (SVR) was achieved in 62 (39.5%) and 24 (45.3%) patients in the whole group and the G4 subgroup respectively. Among the whole cohort and the G4 subgroup, disease progressed in 59 (37.6%) and 21 (39.6%), respectively, with less progression in the SVR groups; 15/62 (24.2%) and 3/24 (12.5%) compared with non-responders; 44 (46.3%) and 18 (62.1%) with P = 0.01 and 0.001 respectively. Multivariate logistic regression analysis showed that having diabetes mellitus (P = 0.03), higher baseline APRI score (P = 0.00) and non-SVR (P = 0.00) were independent predictors of disease progression. G4 patients showed similar results, but 'non-SVR' (P = 0.00) was the only independent predictor of progression. Eight patients died and four developed HCC all among the non-SVR group only.

Conclusions: This study describes, for the first time, the natural history and demonstrates the beneficial long-term effects of interferon-based therapy in HCV G4 patients.
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http://dx.doi.org/10.1111/liv.12127DOI Listing
July 2013

SASLT practice guidelines: management of hepatitis C virus infection.

Saudi J Gastroenterol 2012 Sep;18 Suppl:S1-32

Department of Medicine, Gastroenterology Unit, King Fahad General Hospital, Jeddah, Saudi Arabia.

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http://dx.doi.org/10.4103/1319-3767.101155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713589PMC
September 2012

SASLT practice guidelines for the management of hepatitis C virus infection: summary of recommendations.

Saudi J Gastroenterol 2012 Sep-Oct;18(5):293-8

Department of Medicine, Gastroenterology Unit, King Fahad General Hospital, Jeddah, Saudi Arabia.

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http://dx.doi.org/10.4103/1319-3767.101121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500016PMC
March 2013