Direct medical costs associated with the extrahepatic manifestations of hepatitis C infection in Europe

Abstract

Hepatitis C virus (HCV) infection is a systemic disease associated with both hepatic and extrahepatic manifestations. The burden associated with the hepatic manifestation of HCV infection has been well documented in Europe, although that of HCV extrahepatic manifestations remains unknown. In this study, we estimated the annual direct medical costs associated with HCV extrahepatic manifestations in five European countries. A previously validated economic model was used to estimate the annual direct medical cost associated with HCV extrahepatic manifestations. Global excess prevalence of extrahepatic manifestations in HCV patients relative to that in non-HCV patients was obtained from a recent meta-analysis. Per-patient per-year inpatient, outpatient and medication costs to treat each extrahepatic manifestation were from the literature, national databases or expert opinion if unavailable otherwise. All costs were adjusted to 2016 euros (€). The overall direct medical costs associated with HCV extrahepatic manifestations were calculated by multiplying the total per-patient per-year costs of each by the respective excess prevalence rates and then by the size of the HCV-infected population in each country. Treatment impact with direct-acting antivirals (DAAs) was explored using HCV extrahepatic manifestations excess prevalence rates among cured patients compared to untreated HCV patients, as sourced from a meta-analysis. The total annual direct medical cost associated with HCV extrahepatic manifestations was estimated to be 2.17 billion euro (€), with a per-HCV-patient cost ranging from €899 to €1647 annually. DAA treatment was projected to result in cost savings of €316 million per year. We find that the annual economic burden of extrahepatic manifestations is significant and may be partly mitigated by treatment with DAAs.

Impact of All‐Oral Direct‐Acting Antivirals on Clinical and Economic Outcomes in Patients With Chronic Hepatitis C in the United States

“…Although we did not observe decreased costs in the DAA group among patients without cirrhosis, we believe that over time the savings associated with the avoidance of advanced liver disease and other complications of HCV will be offset, as predicted by several economic investigations in which DAA therapy was found to be cost‐effective in the long term . Furthermore, although we did not study HCV‐associated extrahepatic manifestations in this study, previous investigators found that a large proportion of all‐cause medical costs were attributable to extrahepatic manifestation–related costs in patients with HCV, adding strength to our findings that treatment with DAAs can reduce the high medical costs in patients with HCV by saving in both liver complications and extrahepatic manifestations avoided with cure …”

“…(16)(17)(18)31) Furthermore, although we did not study HCV-associated extrahepatic manifestations in this study, previous investigators found that a large proportion of all-cause medical costs were attributable to extrahepatic manifestation-related costs in patients with HCV, adding strength to our findings that treatment with DAAs can reduce the high medical costs in patients with HCV by saving in both liver complications and extrahepatic manifestations avoided with cure. (14,32,33) It is important to note that in our economic analysis, we estimated that the costs for at least an 8-week DAA treatment course ranged between approximately $100,467 and $123,086. However, the actual cost paid for the DAA therapy may be significantly less than our estimation considering the high rebates and discounts negotiated between pharmaceutical companies and payers.…”

Epidemiological Trend of Sepsis in Patients with Hospital Admissions Related to Hepatitis C in Spain (2000–2015): A Nationwide Study

“…After an episode of decompensation, the risk of death in the following year is between 15% and 20% [ 4 ]. Moreover, chronic hepatitis C causes a substantial economic cost on the National Health Services in Europe, mainly due to the management of patients with advanced liver disease stages [ 5 , 6 , 7 , 8 ].…”

Systematic review with meta‐analysis: extrahepatic manifestations in chronic hepatitis C virus‐infected patients in East Asia

“…One study reported that HCV patients who received anti‐HCV treatment had 30% lower risk of developing CKD . In another study, investigators projected cost savings of €316 million per year owing solely to a decrease in EHMs after treating all HCV patients with direct‐acting antivirals . In the context of similarly high risks of EHMs in HCV‐infected patients from East Asia, it is reasonable to believe that similar savings could be realized; further studies are needed to estimate the economic impact of HCV cure in Asian countries.…”

“…These issues are of great concern since HCV infection is associated not only with increased morbidity and mortality but also with economic losses due to decreased worker productivity and impairment of health‐related quality of life . In addition to hepatic manifestations of HCV (cirrhosis, hepatocellular carcinoma, liver‐related mortality), there are extrahepatic manifestations which add to the clinical, economic and quality of life burden of the infection . Well‐known extrahepatic manifestations of HCV infection include mixed cryoglobulinemia, type 2 diabetes mellitus, chronic kidney disease, lymphoma, lichen planus, Sjogren's syndrome, porphyria cutanea tarda, depression, cardiovascular disease, and rheumatoid arthritis.…”