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Risk-sharing agreements(RSA) allow decision-makers to manage the uncertainty associated with effectiveness and costs of treatments. Our objective was to estimate the economic impact of RSA implementation on treatment of patients diagnosed with rheumatoid arthritis(RA) with certolizumab pegol(CZP) and assess the potential impact of alternative RSA.Under original RSA, treatment with CZP was reimbursed when the response was optimal (DAS28 score3.2) or satisfactory (DAS28 score ≥3.2 and reduction from baseline ≥1.2) at 12 weeks. Alternative RSA would additionally include a 50 % reimbursement for moderate responders(DAS28 score3.2 and ≤5.1, and reduction from baseline between 0.6 and 1.2). We estimated average savings per patient for hospital's pharmacy service(HPS) at 12 weeks, taking into account the pharmacological cost of CZP. Uncertainty associated with effectiveness of CZP was assessed through 1000 Monte Carlo simulations.After 12 weeks of treatment, 57.8 % (n = 52) and 22.2 %(n = 20) of patients had optimal and satisfactory responses, respectively, and average disease activity improved by 1.77 points. Average savings for HPS amounted to 876.9€ and 706.4€ per patient under original and alternative RSA, respectively. Savings in simulated cohort reached 846.2€ and 681.8€ per patient, respectively, leading to estimated net savings for HPS of 846,209€ and 681,790€, respectively.RSA implementation on patients with RA treated with CZP has generated savings and improved efficiency within HPS.

Background: Patients with lung cancer (LC) are at significantly higher risk of developing venous thromboembolism (VTE), which may lead to increased use of health resources and the cost of management. The main aim of the study was to determine the cost of the management of VTE events in patients with LC treated with Low Molecular Weight Heparins (LMWH) in Spain. Methods: Costecat was an, observational, ambispective pharmacoeconomic study. Patients with LC, with a first episode of VTE (symptomatic or incidental) in treatment with LMWH, were recruited from six third-level hospitals and followed up for six months. Sociodemographic, clinical and resource use variables of VTE-related implications and its treatment were collected. Direct healthcare costs and direct non-healthcare costs were recorded. Data collection was documented in an electronic case report. Unit costs were obtained from national databases. Costs (&euro, 2018) were estimated from the healthcare perspective. Statistical analysis was performed using the statistical program R 3.4.3 version (30 November 2017). Results: Forty-seven patients were included. Mean age was 65.4 years, 66.0% were male. The percentage of patients with LC who had metastatic disease was 78.7%. Twenty-three patients (48.9%) needed hospital admissions due to thromboembolic episode. Total average cost of patients with cancer associated VTE (CAT) was &euro, 109,696.6 per patient/semester. The hospitalizations represent 65.8% of total costs (7207.3 &euro, SD 13,996.9 &euro, ), followed by LMWH therapy which represents 18.6% (2033.8 &euro, SD:630.5 &euro, ). Conclusions: Venous thromboembolism episodes induce an economic impact on patients and healthcare systems. Direct healthcare costs are the major burden of the total cost, in which hospitalizations are the main drivers of cost.

Introduction: Hospital pharmacists are increasingly playing a critical role in the care of patients with multiple sclerosis (MS). However, little is known about their preferences and perspectives towards different attributes of disease-modifying therapies (DMTs). The objective of this research was to assess pharmacists&acute, preferences for DMT efficacy attributes. Methods: A multicenter, non-interventional, cross-sectional, web-based study was conducted. Preventing relapses, delaying disease progression, controlling radiological activity, and preserving health-related quality of life (HRQoL) and cognition were the attributes selected based on a literature review and a focus group with six hospital pharmacists. Conjoint analysis was used to determine preferences in eight hypothetical treatment scenarios, combining different levels of each attribute and ranking them from most to least preferred. Results: Sixty-five hospital pharmacists completed the study (mean age: 43.5 &plusmn, 7.8 years, 63.1% female, mean years of professional experience: 16.1 &plusmn, 7.4 years). Participants placed the greatest preference on delaying disease progression (35.7%) and preserving HRQoL (21.6%) and cognition (21.6%). Importance was consistent in all groups of pharmacists stratified according to demographic characteristics, experience, research background, and volume of patients seen per year. Conclusions: Understanding which treatment characteristics are meaningful to hospital pharmacists may help to enhance their synergistic role in the multidisciplinary management of patients with MS.

Multiple myeloma is a very heterogeneous disease with variable survival. Despite recent progress and the widespread use of new agents, patients with relapsed and refractory disease have a poor outcome. Immunomodulatory drugs play a key role in both the front-line and the relapsed/refractory setting. The combination of pomalidomide (POM) and dexamethasone is safe and effective in relapsed and refractory patients, even in those with high-risk cytogenetic features. Furthermore, it can be used in most patients without the need to adjust according to the degree of renal failure. In order to further improve the results, POM-based triplet therapies are currently used. This article highlights the most relevant issues of POM and POM-based combinations in the relapsed/refractory multiple myeloma setting, from a pharmacological and clinical point of view., Video abstract

Objective To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guia Espanola para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with a better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.

Background According to OMS-2016, myelodysplastic syndrome (MDS) associated with del(5q) is manifested by a transfusion-dependent progressive bone marrow failure, with Lenalidomide acting as the intended drug to treat this syndrome. Purpose To analyse the clinical impact of the directed risk-stratification therapy and to evaluate the clinical benefit associated with the discontinuation of the Lenalidomide treatment due to side effects or intolerance. Material and methods Three-year prospective observational study on 69 cases of MDS in a third-level hospital, 17 of them with del(5q). Mutational profile analysis using a Next Generation Sequencing (NGS) on a panel of 28 genes mutated in haematologic malignancies prior to Lenalidomide treatment decision-making, with TP53 mutation as ultra-high-risk profile for discouraging its use. Variables considered: beginning of treatment, Lenalidomide mean dose, ending of treatment and beginning of discontinuation, side effects, time after discontinuation, evaluation of the drug withdrawal response and cost savings. Results Sixty-nine MDS cases were analysed by NGS. Mutational risk profile: high (six), low (21), intermediate (18), very high (seven) and very low (17). Seventeen cases were detected as MDS associated with del(5q) and five of them showed positive TP53 mutation and were treated with hypomethylating agents instead of Lenalidomide. Seven of them showed DNMT3A, ASXL1, SF3B1 and TET2 mutations. Eleven patients were treated with Lenalidomide, the treatment was discontinued in six of them due to side effects and the dose reduced in three cases due to intolerance. Reported side effects: Grade 4 neutropaenia, rhabdomyolysis, erythematous reactions and haemolytic crisis. All patients in which Lenalidomide was discontinued, maintained complete haematological and cytogenetic response, reaching a mean monitoring time of 12 months since the withdrawal of Lenalidomide. The cost saving associated with the discontinuation of Lenalidomide 10 mg was €48 000 per patient per year. Conclusion The use of NGS permits the selection of the mutational profile of each patient, resulting in a change in therapeutic decision-making, the selection of more cost-effective drugs and a directed and personalised treatment. Discontinuation of Lenalidomide, due to side effects or intolerance, involves a clinical benefit to those patients who maintain a complete haematological response after interruption of the treatment. Reference and/or acknowledgements Chesnais, et al. Blood 2016;127:749–60. No conflict of interest.

Treatment with interferon beta (IFNβ) is one of the first-line treatments for multiple sclerosis. In clinical practice, however, many patients present suboptimal response to IFNβ, with the proportion of non-responders ranging from 20 to 50%. This variable response can be affected by genetic factors, such as polymorphisms in the genes involved in the disease state, pharmacodynamics, metabolism or in the action mechanism of IFNβ, which can affect the efficacy of this drug. This review assesses the impact of pharmacogenetics studies on response to IFNβ treatment among patients diagnosed with relapsing-remitting multiple sclerosis (RRMS). The results suggest that the detection of polymorphisms in several genes (CD46, CD58, FHIT, IRF5, GAPVD1, GPC5, GRBRB3, MxA, PELI3 and ZNF697) could be used in the future as predictive markers of response to IFNβ treatment in patients diagnosed with RRMS. However, few studies have been carried out and they have been performed on small sample sizes, which makes it difficult to generalize the role of these genes in IFNβ treatment. Studies on large sample sizes with longer term follow-up are therefore required to confirm these results.

Archaeological materials are a finite resource, and efforts should be made to minimize destructive analyses. This can be achieved by using protocols combining extraction of several types of biomolecules or microparticles, which decreases the material needed for analyses while maximizing the information yield. Archaeological dental calculus is a source of several different types of biomolecules, as well as microfossils, and can tell us about the human host, microbiome, diet, and even occupational activities. Here, we present a unified protocol allowing for simultaneous extraction of DNA and proteins from a single sample of archaeological dental calculus. We evaluate the protocol on dental calculus from six individuals from a range of time periods and estimated preservation states, and compare it against previously published DNA-only and protein-only protocols. We find that most aspects of downstream analyses are unaltered by the unified protocol, although minor shifts in the recovered proteome can be detected, such as a slight loss of hydrophilic proteins. Total protein recovery depends on both the amount of starting material and choice of extraction protocol, whereas total DNA recovery is significantly reduced using the unified protocol (mean 43%). Nevertheless, total DNA recovery from dental calculus is generally very high, and we found no differences in DNA fragment characteristics or taxonomic profile between the protocols. In conclusion, the unified protocol allows for simultaneous extraction of two complementary lines of biomolecular evidence from archaeological dental calculus without compromising downstream results, thereby minimizing the need for destructive analysis of this finite resource. 1. Introduction 2. Methods 2.1. Sample material 2.2. Laboratory procedures 2.2.1. Sample collection and preparation 2.2.2. DNA-only (DO) protocol 2.2.3. Protein-only (PO) protocol 2.2.4. Unified protocol (UP) 2.2.5. DNA sequencing 2.2.6. LC-MS/MS 2.3. Analysis workflow 2.3.1. Genetic analysis 2.3.1.1. DNA recovery 2.3.1.2. Data preprocessing 2.3.1.3. Fragment characteristics 2.3.1.4. Microbiome reconstruction 2.3.1.5. Contamination 2.3.2. Proteomic analysis 2.3.2.1. Protein recovery 2.3.2.2. Data preprocessing 2.3.2.3. Protein characteristics 2.3.2.4. Proteome reconstruction 2.3.2.5. Contamination 3. Results 3.1. Genetic analysis 3.1.1. DNA recovery 3.1.2. DNA fragment characteristics 3.1.3. Microbiome reconstruction 3.1.4. Contamination 3.2. Proteomic analysis 3.2.1. Protein recovery 3.2.2. Protein characteristics 3.2.3. Proteome reconstruction 3.2.4. Contamination 4. Discussion and conclusions

We evaluated the influence of clinical, biochemical, and genetic factors on response in 142 patients diagnosed with rheumatoid arthritis, of whom 87 patients were treated with tocilizumab (61.26%) and 55 patients were treated with rituximab (38.7%;) according to the variables European League Against Rheumatism (EULAR) response, remission, low disease activity, and improvement in Disease Activity Score, 28 joints (DAS28) at 6, 12, and 18 months. A retrospective prospective cohort study was conducted. Patients carrying the FCGR3A rs396991-TT genotype treated with tocilizumab showed higher EULAR response (OR, 5.075; 95%CI, 1.20-21.33; P = .027) at 12 months, those who were naive for biological disease-modifying antirheumatic drugs (bDMARDs) at the beginning of treatment showed satisfactory EULAR response, higher remission, and greater improvement in DAS28 at 6 months. Younger age at start of tocilizumab treatment was associated with satisfactory EULAR response at 18 months and greater remission at 6 and 18 months. Subcutaneous tocilizumab administration was associated with higher remission at 6 months and improved low disease activity rate at 12 months. In patients treated with rituximab, carriers of the FCGR2A rs1801274-TT genotype had higher EULAR response at 6 months (OR, 4.861; 95%CI, 1.11-21.12; P = .035), 12 months (OR, 4.667; p = 0.066, 95%CI, 0.90-24.12; P = .066), and 18 months (OR, 2.487; 95%CI, 0.35-17.31; P = .357), higher remission (OR: 10.625; p = 0.044, CI95% : 1.07, 105.47) at 6 months, and greater improvement in DAS28 at 12 months (B = 0.782; 95%CI, -0.15 to 1.71; P = .098) and 18 months (B = 1.414; 95%CI, 0.19-2.63; P = .025). The FCGR3A rs396991-G allele was associated with improved low disease activity rate (OR, 4.904; 95%CI, 0.84-28.48; P = .077) and greater improvement in DAS28 (B = -1.083; 95%CI, -1.98 to -0.18; P = .021) at 18 months. Patients with a lower number of previous biological therapies had higher remission at 12 months. We suggest that the FCGR3A rs396991-TT genotype, higher baseline value of DAS28, subcutaneous tocilizumab administration, younger age at the beginning of treatment, and being bDMARD naive are associated with better response to tocilizumab. In patients treated with rituximab, we found better response in those patients with the FCGR2A rs1801274-TT genotype, the FCGR3A rs396991-G allele, and lower number of previous biological therapies.

Background Cabazitaxel is used in the treatment of metastatic prostate cancer. It is not a substrate of P-glycoprotein, which is involved in cellular detoxification of chemotherapeutic agents and in the expulsion of drugs at blood-brain barrier. Our objectives are to test Cabazitaxel in vitro in malignant neural cell lines such as glioblastoma, anaplastic glioma and neuroblastoma, and to find any predictor of response that allows us to select potential responder patients in glioblastoma multiforme and other neural tumors. Methods Cell lines A172 (glioblastoma, p53 wild type), LN229 (glioblastoma, p53 mutated), SF268 (anaplastic glioma, p53 mutated) and SK-N-SH (neuroblastoma, p53 wild type) were cultured in 48-well plates and increasing doses of Cabazitaxel were tested (0.1, 0.5, 1, 5, 10, 25, 50, 100μM). After 48hours of treatment, the proliferation values were studied by spectrophotometric assays. Also, gene expression studies of the MMR complex (miss-match repair) were performed by RT-qPCR for the primers of MLH1, MSH2, MSH3, MSH6, PMS2 genes. We also analyzed the expression of CD133 marker by RT-qPCR assays. A PCR study with Bisulfite kit was carried out to detect the promoter methylation of MGMT. Results IC50 values at 48hours were 13.76μm in SF268, 6.77μm in SK-N-SH, 2.88μm in LN 229 and 1.34 in A172. The expression values of MMR complex proteins were significantly higher in line A172 (relative value 1), followed by line LN229 (0.25) and negative in lines SK-N-SH and SF268. The methylation of MGMT promoter was positive in lines A172 and LN229. Finally, the expression of CD133 was higher in A172 (0.6), followed by LN229 (0.4), SK-N-SH (0.2) and SF268 (0). Pearson correlation coefficient for the relationship between CD133 expression and IC50 values is -0.96. Conclusions 1. Glioblastoma, anaplastic glioma and neuroblastoma cell lines have a high sensitivity to Cabazitaxel in vitro. 2. Cell lines with MGMT methylation and MMR expression (A172 and LN 229) are the most sensitive. Of them, line A172 presents a p53 wild type, and therefore, a greater sensitivity to Cabazitaxel. 3. The expression of CD133 correlates inversely with the values of IC50 to Cabazitaxel, and may also be a predictor of response. Legal entity responsible for the study UGR. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background: fewer than half of patients infected with hepatitis C virus (HCV) achieve sustained viral clearance after peginterferon alfa/ribavirin (Peg-IFN/RBV) therapy. Aims: thalidomide posses anti-inflammatory and immunomodulatory properties through inhibition of tumor necrosis factor and costimulatory effect on human CD8+ T cells. Methods: we started a prospective, open label trial of retreatment of very-difficult-to-treat genotype 1 chronic hepatitis C patients (CHC) patients, who had failed to respond to the (Peg-IFN/RBV), with a triple therapy consisting in these same antivirals plus thalidomide 200 mg/day (the TRITAL study). Results: none of the eleven patients fulfilling the inclusion criteria and included in the trial reached complete early virological response or sustained virological response. Viral load decline after 12 weeks of triple therapy thalidomide-based retreatment did not differ from viral dynamics during the first course. The triple therapy was well tolerated and only one patient developed mild bilateral neuropathy. Conclusions: thalidomide addition to standard therapy is tolerated and did not increase the SVR rate in very-difficult-to-treat genotype 1 CHC patients. Different schedules are warranted to improve attempting retreatment of non responder CHC patients.

Background Inosine triphosphatase (ITPA) genotyping is used for predicting anaemia in patients with genotype 1 chronic hepatitis C. The AA and CA genotypes have the lowest incidence of anaemia. Purpose To compare the incidence of anaemia, the reduction in ribavirin (RBV) dose and the use of darbepoetin in patients treated with boceprevir or telaprevir before and after the introduction of ITPA genotyping in a tertiary care hospital. Material and methods Observational, pre-post intervention study using pharmacotherapeutic records of patients treated with telaprevir or boceprevir before and after the introduction of ITPA genotyping. Anaemia was defined as haemoglobin (Hb) Results Before genotyping 37 patients were included (27 male, 10 female): Mean fibroscan was 22 kpa, mean basal Hb was 15.6 mg/dL and mean nadir Hb was 10.4 mg/dL. After genotyping 20 patients were included (16 male, 4 female): 18 patients were CC (90%) and two were AC (10%). Mean fibroscan was 11.9 kpa (significantly lower than before genotyping). Mean basal Hb was 16.1 mg/dL and mean nadir Hb was 10.9 mg/dL. Comparison of before and after results. Reduction in RBV dose: 43.2% vs. 40% (p = n.s.); anaemia: 35.1% vs. 45% (p = n.s.); and treatment with darbepoetin: 32.4% vs. 25% (p = n.s.) Conclusion Although the reduced use of darbepoetin suggests the practical utility of this resource, a higher percentage of patients experienced anaemia after ITPA genotyping was available. This is possibly because the RBV dose was reduced by less than before genotyping even though 90% of patients were the CC (pro-anaemia) genotype. Greater emphasis should be placed on this resource. No conflict of interest.

Background Boceprevir (BOC) and telaprevir (TLV) have been approved recently for the treatment of chronic hepatitis C virus (HCV) infection but their safety remains to be studied. Purpose To analyse the incidence of adverse events (AEs) in patients treated with BOC and TLV according to their previous response to treatment with interferon and ribavirin. Materials and methods Retrospective, observational, multicentre study. Adverse events (AEs) and analytical data were collected from pharmacotherapeutic records of patients who started treatment with TLV or BOC between January 2012 and January 2013. Anaemia was defined as haemoglobin 3 /mm 3 and thrombocytopenia: platelet count 3 . The variables were: previous response to treatment: treatment-naive (N), non-responder (NR) or patient who had a relapse (R), age, sex, FibroScan, nadir haemoglobin, neutrophil count, platelet count, presence of rash and anorectal discomfort. The number of patients requiring erythropoietin (EPO) and filgrastim were recorded. Results 78 patients were investigated, the mean age was 50.9 years and 21 were women. Mean FibroScan value was 18.2 kPa. Patients: N = 19; (24.3%), NR = 29 (37.2%) and R = 30 (38.5%). The incidence of AEs were: a) hematologic: anaemia 47.4% (N), 55.5% (NR) and 60% (R); thrombocytopenia: 31.6% (N), 69% (NR) and 40% (R) and neutropenia: 5.3% (N), 34.5% (NR) and 20% (R). b) Dermatologic: pruritus 15.8% (N), 31% (NR) and 40% (R); rash: 31.6% (N), 17.2 (NR) and 10% (R) and anorectal discomfort: 0% (N), 17.2% (NR) and 40% (R). The percentage of patients requiring EPO: N = 26.3%, NR = 20.7% and 6.7% (R). Filgrastim was only used in four NR. Conclusions Haematological AEs: R patients showed a higher incidence of anaemia, conversely EPO was used in 26.3% of N patients indicating more severe anaemias. Neutropenia and thrombocytopenia were more frequent in NR. Dermatological AEs: Pruritus and anorectal discomfort were more common in R patients, nevertheless rash was more frequent in N patients. No conflict of interest.

Background Despite the expanding knowledge base, much remains to be understood about effective treatments to treat the many symptoms of anti-NMDA receptor encephalitis (anti-NMDA RE). Purpose To describe the treatment options for a case of refractory status epilepticus associated with non paraneoplastic anti-NMDA RE. Materials and Methods Revised drug-treatment history of the patient. Results A 22-year-old woman with a family history of epilepsy and an arteriovenous malformation (AVM) of the brain, presented a generalised tonic-clonic without clear focal onset and post-critical confusion. She was in non-convulsive status epilepticus. Treatment was initiated with various intravenous drugs during the 50 days of the status: diazepam, phenytoin, valproic acid, levetiracetam, clonazepam, midazolam, propofol, lacosamide, ketamine, and lidocaine. It was decided to proceed with induction of barbiturate coma three times, requiring supratherapeutic doses in the second one. Oxcarbazepine was administered via feeding tube. With these treatments, momentary remission status was achieved although epileptiform activity reappeared when the pharmacological effect expired. Thirty days after admission, it was decided to repeat computed tomography for development of AVM and investigate again whether the cerebrospinal fluid was positive for anti-NMDA. This being the case, teatment was initiated with methylprednisolone and immunoglobulins. She continued with clinical status, but electrical brain activity began to fade at the same time that the patient was starting to tolerate enteral nutrition and so oxcarbazepine possibly began to be absorbed. After discontinuing sedation the patient awoke and opened her eyes. Electroencephalogram was repeated and epileptiform activity had disappeared completely. Facial dyskinesias were treated with clonazepam. Conclusions Whereas the best treatment approach for anti-NMDA RE encompasses a combination of immunotherapy, intensive care, and rehabilitation, there is a dearth of information regarding management of psychiatric and behavioural symptoms [1]. The possibility of resolving the status by oxcarbazepine gavage opens a window into the use of drugs by this route in the event of failure of standard treatment. Reference Sansing LH, Tuzun E, Ko MW, Baccon J, Lynch DR, Dalmau J. A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol . 2007 May;3(5):291–6. No conflict of interest.

Background Recent marketing authorizations for the first protease inhibitors for hepatitis C virus (HCV) have changed the management of chronic hepatitis C patients. However, it should be noted that the cost, number as well as the severity of adverse effects will increase. It is therefore reasonable to adopt criteria to ensure maximum efficiency and patient safety. IL-28B polymorphism is one of the factors associated with the treatment outcome and has been closely linked to interferon response. Purpose To describe the implementation of the determination of the IL-28B polymorphism, rs12979860, and the results obtained, in order to personalise the treatment in HCV mono-infected patients in a tertiary hospital. Materials and Methods We designed a standard form for HCV patients starting treatment with protease inhibitors. It includes several items that require clinical evaluation: viral load, HCV genotype, FibroScan and/or liver biopsy, response to previous treatment and polymorphism of the IL-28B genotype. Homozygous CC is the favourable genotype, predicting a good response. CT and TT genotypes are considered unfavourable. The test was conducted in the pharmacogenetics area of the pharmacy department. To calculate the response time, we considered how long it takes to get the different responses. The results were added to the hospital’s electronic medical records programme for easy reference online. Results A total of 26 genotypes was determined, of which 11 (42%) were requested by the department of infectious diseases (56% co-infected), 10 (38%) by the hepatology department and 5 (18%) by an external department. Results 15 (58%) were CT, 8 (31%) CC and 3 (11%) TT. 100% of patients had a score of FibroScan > 9.5 kPascal. The response for the tests was on average 3 to 7 days, with the limiting factor the sequencer availability. Conclusions IL28B determination has been added to the hospital’s services portfolio as a clinical assessment tool for the treatment of hepatitis C, with a response time of 3–7 days. No conflict of interest.