Hepatitis C in the era of direct-acting antivirals: real-world costs of untreated chronic hepatitis C; a cross-sectional study

BMC Infectious Diseases

Michael Barry²  Colm Bergin⁵  Susan McKiernan⁵  P. Aiden McCormick¹  D. Houlihan¹  Raphael Merriman¹  Cathal Walsh³  Aisling O’Leary⁴  Suzanne Norris⁵  Jennifer Ann Kieran² 

[1] Liver Unit, St. Vincent’s University Hospital, Dublin, Ireland;National Centre for Pharmacoeconomics, St. James Hospital, Dublin, Ireland;MACSI and Health Research Institute, University of Limerick, Limerick, Ireland;School of Pharmacy, Royal College of Surgeons of Ireland, Dublin, Ireland;School of Medicine, Trinity College Dublin, Dublin, Ireland

关键词: Pharmacoeconomics;    Hepatitis C;    Direct medical cost;    Health economics;    Ireland;   

Others  :  1232804
DOI  :  10.1186/s12879-015-1208-1

 received in 2014-11-18, accepted in 2015-10-12,  发布年份 2015

【 摘 要 】

Background

Recent advances in Hepatitis C therapeutics offer the possibility of cure but will be expensive. The cost of treatment may be partially offset by the avoidance of advanced liver disease. We performed a micro-costing study of the ambulatory healthcare utilisation of patients with Hepatitis C supplemented with inpatient diagnosis related group costs.

Methods

The staff utilisation costs associated with a Hepatitis C ambulatory visit were measured and combined with the costs of investigations to establish a mean cost per consultation. An annualised estimate of cost was produced by multiplying this by the number of consultations accessed, stratified by degree of liver impairment. Inpatient costs were established by identifying the number of inpatient episodes and multiplying by Irish diagnosis related group costs. Non-parametric bootstrapping was performed to derive mean and 95%CI values.

Results

Two hundred and twenty-five patients were identified. The cost of an outpatient medical review was €136 (€3.60 SD). The cost of a Hepatitis C nursing review was €128 (€7.30 SD). The annual mean costs of care were as follows (95%CI): Mild €398 (€336, €482), Moderate €417(€335, €503), Compensated cirrhosis €1790 (€990, €3164), Decompensated cirrhosis €8302 (€3945, €14,637), Transplantation Year 1 €137,176 (€136,024, €138,306), Transplantation after Year 1 €5337 (€4942, €5799), Hepatocellular carcinoma €21,992 (€15,222, €29,467), Sustained virological response €44 (€16, €73).

Conclusions

The direct medical cost associated with Hepatitis C care in Ireland is substantial and increases exponentially with progression of liver disease. The follow-up costs of patients with a sustained virological response in this cohort were low in comparison to patients with chronic infection.

【 授权许可】

   
2015 Kieran et al.

【 图 表 】

Fig. 1.

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