Characteristics and Healthcare Costs in the Aging Hepatitis B Population of Japan: A Nationwide Real-World Analysis

Abstract

Introduction: Advancing age, comorbidity, and financial burden have been observed in chronic hepatitis B (CHB) patients globally. As Japan is leading the world in aging demographics, similar real-world data are urgently needed for its CHB population to inform all stakeholders. Methods: This cross-sectional study characterized the demographics, comorbidities, and healthcare costs of a large Japanese real-world adult (≥18 years) CHB patient (ICD-10: B18.1) population from the Medical Data Vision database from 01/01/2012 to 31/12/2016. Comorbidities were identified by ICD-10 codes and the annual point-prevalence and Charlson Comorbidity Index (CCI) score were calculated. Annual mean and median all-cause healthcare utilization and costs per-patient were calculated. Comparison tests were conducted for CCI scores, prevalence of comorbidities and healthcare resource utilization and costs. Results: We identified 11,125 CHB patients. Between 2012 and 2016, the mean age increased from 62.0±13.3 to 65.2±13.2 years, and the percentage of those aged ≥65 years increased from 45.6% to 60.7%. The prevalence of cirrhosis remained similar (5.8% in 2012 and 5.6% in 2016, p=0.69) while hepatocellular carcinoma decreased from 6.3% to 4.5% (p<0.01). The prevalence of non-liver comorbidities increased (40.9% to 52.0% for cancer (p<0.01), 12.1% to 17.7% for osteoporosis (p<0.01), and 10.7% to 15.0% for renal impairment (p<0.01). Healthcare resource utilization and costs also increased, with a 119.3% increase in the median total healthcare costs from ¥229,143 in 2012 to ¥502,467 in 2016 (p<0.01). Conclusions: The CHB population of Japan is predominantly elderly and carry a high non-liver comorbidity burden, while incurring increasing healthcare costs.

Increased Risk of Liver-Related Outcomes in Chronic Hepatitis B Patients with Metabolic Syndrome: A Systematic Review and Meta-Analysis

“…Recent data have suggested that patients with CHB have aged globally in the past decade [ 36 , 37 , 38 , 39 , 40 ], and as such, the prevalence of CHB patients with comorbidities including MetS has increased substantially, furthering highlighting the need for further research in this area. Additionally, data regarding the underlying biologic mechanisms between chronic HBV infection and MetS remains sparse.…”

Advanced hepatocellular carcinoma and palliative care: a scoping review

“…Another significant finding from this study was the divergence from the perspectives of patients and family caregivers on information needs and decision-making. Unmet informational demands are often recognised in patients with advanced cancer and family caregivers in general and occur earlier in the HCC disease course 50. Additional problems arise as a result of the numerous communication issues, such as difficulty in verbalising and ambiguity regarding the best method to inform the prognosis.…”

Treatment Algorithm for Managing Chronic Hepatitis B Virus Infection in the United States: 2021 Update

“…Furthermore, following the fourth decade of life, physiologic renal function decline is expected at about 8 mL/min/1.73m per decade, 64 which is very relevant as the CHB population continues to age, with 42% already 55 years or older in 2015 in the United States as as high as 60% being 65 years or older in 2016 elsewhere such as Japan. [65][66][67][68][69] Notably, observational data from population-based studies from both the United States and Asia have also found CHB to associate with higher prevalence and incidence of chronic kidney disease. 65,[70][71][72] For patients at risk of nephrotoxicity or for those taking TDF, 73 creatinine clearance (eGFR) and serum phosphorus should be monitored every 3 months during the first year of therapy.…”