All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

Abstract

• Annual total direct and indirect costs related to infections with the hepatitis C virus (HCV) in the United States were estimated at $5.46 billion in 1997. Davis et al. (2011) estimated that all-cause health care costs for managed care organization (MCO) enrollees with HCV were $20,961 per patient per year (PPPY), of which $6,864 PPPY was HCV-related, from 2002 through 2006.• The burden of illness for HCV is predicted to grow over the next 2 decades, partly due to increased prevalence of advanced liver disease (AdvLD) in the current HCV population. What is already known about this subjectAll-Cause and METHODS: This retrospective, matched cohort study included patients aged at least 18 years and with at least 6 months of continuous enrollment in a large managed care organization (MCO) claims database from July 1, 2001, through March 31, 2010. Patients with a diagnosis of HCV (ICD-9-CM codes 070.54, 070.70) were identified and stratified into those with and without AdvLD, defined as decompensated cirrhosis (ICD-9-CM codes 070. 44, 070.71, 348.3x, 456.0, 456.1, 456.2x, 572.2, 572.3, 572.4, 782.4, 789.59); hepatocellular carcinoma (HCC, ICD-9-CM code 155); or liver transplant (ICD-9-CM codes V42.7, 50.5 or CPT codes 47135, 47136). For patients without AdvLD, the index date was the first HCV diagnosis date observed at least 6 months after the first enrollment date, and at least 6 months of continuous enrollment after the index date were required. HCV patients without AdvLD were stratified into those with and without compensated cirrhosis (ICD-9-CM codes 571.2, 571.5, 571.6). For patients with AdvLD, the index date was the date of the first AdvLD diagnosis observed at least 6 months after the first enrollment date, and at least 1 day of enrollment after the index date was required. Cases were matched in an approximate 1:10 ratio to comparison patients without an HCV diagnosis or AdvLD diagnosis who met all other inclusion criteria based on gender, age, hospital referral region state, pre-index health care costs, alcoholism, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and a modified Charlson Comorbidity Index. For the HCV and comparison patient cohorts, PPPY all-cause costs to the payer were calculated as total allowed charges summed across all patients divided by total patient-days of follow-up for the cohort, multiplied by 365, inflation-normalized to 2009 dollars. Because the calculation of PPPY cost generated a single value for each cohort, bootstrapping was used to generate descriptive statistics. Incremental PPPY costs for HCV patients relative to non-HCV patients were calculated as between-group differences in PPPY costs. T-tests for independent samples were used to compare costs between case and comparison cohorts.RESULTS: A total of 34,597 patients diagnosed with HCV, 78.0% with HCV without AdvLD, 4.4% with compensated cirrhosis, 12.3% with decompensated cirrhosis, 2.8% with HCC, and 2.6% with liver transplant, were matched to 330,435 comparison patients. Mean (SD) age of al...

Treatment Patterns, Health Care Resource Utilization, and Costs in U.S. Patients Diagnosed with Chronic Hepatitis C Infection Who Received Telaprevir or Boceprevir

“…4,5 Prior to 2011, standard therapy for CHC was combination therapy consisting of peginterferon alfa (PEG) and ribavirin (RBV). In May 2011, 2 direct-acting antiviral agents (DAA), telaprevir and boceprevir, were approved by the U.S. Food and Drug Administration (FDA) for treatment of HCV genotype 1 in combination with PEG and RBV (triple therapy).…”

All-Cause and Potentially Disease-Related Health Care Costs Associated with Venous Thromboembolism in Commercial, Medicare, and Medicaid Beneficiaries

“…To avoid overestimating costs by annualizing data for patients observed for less than 1 year, we calculated costs per patient per year (PPPY) by weighting each patient's cost outcomes by length of follow-up. 34,35 Because the normality assumption might not be valid for cost-outcome variables, we conducted nonparametric estimations (i.e., bootstrap method) to carry out statistical inference and determine per 100 patient-years to account for variable length of followup. The absolute risk of an event was calculated as the number of patients with the event divided by the total number of patients.…”

Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

“…Hastaların virusla karşılaşma yaşına göre hastalığın prognozu dikkate alındığında HCV'ye bağlı ilerlemiş karaciğer hastalığının maliyeti US $27 845, HSK'nin maliyeti US $43 671, transplantasyonun maliyeti ise US $93 609 olarak bildirilmiştir (31,32). Çoğu hastada ciddi komplikasyon geliş-meyecek olsa da dekompanse karaciğer hastalığının ve ka- raciğer transplantasyonunun maliyeti, yaşam süresi, hastalık maliyeti ve antiviral tedavi maliyeti dışında US $24 000-39 000 dolaylarındadır (33,34).…”

“…Bu nedenle, hangi hastada hangi rejim seçilirse hangi oranda yanıt alınacağı hesaplanarak, uygunsa, mevcut rejimlerle başlan-malı; uygun değilse, hasta, daha iyi yanıt alınabilecek tedavi rejimleri kullanıma girene değin bekletilmelidir. Sağlık Uy- (32). Önümüzdeki 10-20 yıl içinde AHC insidansının azalması-na karşın, siroz ve HSK insidansının artması beklenmektedir (48).…”