Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection

Hepatitis C virus (HCV) infection increases total healthcare costs but the effect of the severity of liver disease associated with chronic hepatitis C (CHC) on healthcare costs has not been well studied. We analyzed the demographics, healthcare utilization, and healthcare costs of CHC patients in a...

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Published in:Hepatology (Baltimore, Md.) Md.), 2012-11, Vol.56 (5), p.1651-1660
Main Authors: Gordon, Stuart C., Pockros, Paul J., Terrault, Norah A., Hoop, Robert S., Buikema, Ami, Nerenz, David, Hamzeh, Fayez M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Ambulatory Care - economics
Ambulatory Care - utilization
Antiviral Agents - economics
Antiviral Agents - therapeutic use
Biological and medical sciences
Costs
Databases, Factual
Drug Costs - statistics & numerical data
End Stage Liver Disease - economics
End Stage Liver Disease - therapy
Female
Gastroenterology. Liver. Pancreas. Abdomen
Health Care Costs - statistics & numerical data
Health Services - economics
Health Services - utilization
Hepacivirus
Hepatitis
Hepatitis C
Hepatitis C, Chronic - complications
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - economics
Hepatology
Hospitalization - economics
Hospitalization - statistics & numerical data
Human viral diseases
Humans
Infectious diseases
Insurance, Health - statistics & numerical data
Liver cirrhosis
Liver Cirrhosis - economics
Liver Cirrhosis - therapy
Liver diseases
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Retrospective Studies
Severity of Illness Index
United States
Viral diseases
Viral hepatitis
Young Adult
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Summary:Hepatitis C virus (HCV) infection increases total healthcare costs but the effect of the severity of liver disease associated with chronic hepatitis C (CHC) on healthcare costs has not been well studied. We analyzed the demographics, healthcare utilization, and healthcare costs of CHC patients in a large U.S. private insurance database (January, 2002 to August, 2010), with at least 1 year of baseline enrollment and 30 days of continuous follow‐up. Patients were stratified by liver disease severity: noncirrhotic liver disease (NCD), compensated cirrhosis (CC), and endstage liver disease (ESLD), as defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9) codes. Mean all‐cause and HCV‐related healthcare costs per‐patient‐per‐month (PPPM) during follow‐up (mean 634 days) are reported in 2010 U.S.$ from the payer's perspective. A total of 53,796 patients with CHC were included (NCD: 41,858 [78%]; CC: 3,718 [7%]; and ESLD: 8,220 [15%]). Mean all‐cause PPPM healthcare costs were 32% and 247% higher for patients with CC and ESLD compared to those with NCD ($1,870 and $4,931 versus $1,420; P < 0.001) and were independent of age or comorbid conditions. Pharmacy, ambulatory, and inpatient care collectively accounted for 90% of NCD costs and 93% of CC and ESLD costs. The largest cost components were inpatient costs for those with ESLD (56%) and ambulatory costs for those with CC and NCD (37% and 36%, respectively). Overall, 56% of costs were HCV‐related and this proportion increased with severity (46%, 57%, and 71% for patients with NCD, CC, and ESLD, respectively). Conclusion: The direct healthcare costs associated with CHC are high, increase in association with the progression of liver disease, and are highest in those with ESLD. (HEPATOLOGY 2012;56:1651–1660)
ISSN:0270-9139
1527-3350
DOI:10.1002/hep.25842