Reduction in hepatitis C‐related hospitalizations after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System: regional level differences

Abstract

This work evaluates the potential impact at territorial level of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System on hepatitis C virus (HCV)‐associated hospitalizations. Chronic HCV‐related hospitalization discharges from 2014 to 2018 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalizations was performed for all chronic, advanced liver disease and non‐advanced liver disease. Hospitalization rates were calculated at national and regional level. Year 2015 and period 2016–2018 hospitalization rates were compared to 2014 hospitalization rates using a Poisson model. Municipal standardized hospitalization rates ratios adjusted by age‐group were calculated for 2016–2018 period (2014 hospitalization rates as reference). From 2014 to 2018, there were 22,352 chronic HCV‐related hospitalizations. In‐hospital fatality rate was 4.3% for non‐advanced liver disease and 11.7% for advanced liver disease patients. National hospitalization rate decreased 22% (95% CI: 21%–22%), 16% (95% CI: 15%–17%) and 34% (95% CI: 33%–35%) in 2016–2018 compared to 2014 for all chronic, non‐advanced and advanced liver disease, respectively. During 2016–2018 period, 11/19 Spanish regions achieved >20% decrease in the hospitalization rates (p < .001) for non‐advanced liver disease and 19/19 (except Melilla, the rest with p < .001) for advanced liver disease. At municipal level, 84.8% and 90.2% municipalities had <20% of chronic HCV‐related hospitalization need compared to 2014 adjusted by age‐group. Based on the data analysed, a high impact on reducing chronic HCV‐associated hospitalizations have been achieved after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System. However, small differences between regions and rural/urban areas were noticed.

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“…Las directrices de 2018 del Centro Europeo para la Prevención y el Control de Enfermedades (ECDC) recomiendan la implementación de estrategias nacionales de cribado integrales, así como proveer una adecuada vinculación a la atención de las personas afectadas 7 . A pesar de que el PEAHC ha contribuido positivamente a reducir el número de hospitalizaciones atribuidas al VHC 8 , todavía hay una proporción significativa de pacientes que desconocen su condición, lo que supone que muchos pacientes acaben siendo hospitalizados con diagnóstico tardío y cirrosis descompensada 4,9 .…”

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“…Strategies that include implementation and prioritization of treatment for patients with end-stage liver disease (including those on a transplant waiting list) have clearly met with success. Following the introduction of the strategic plan, both HCVrelated hospitalizations and the number of patients on the liver transplant waiting list have significantly decreased (45)(46)(47).…”