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

BMC Infectious Diseases

Research Article

Colm Bergin¹  Susan McKiernan²  Suzanne Norris²  Michael Barry³  Jennifer Ann Kieran³  D. Houlihan⁴  P. Aiden McCormick⁴  Raphael Merriman⁴  Cathal Walsh⁵  Aisling O’Leary⁶ 

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

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

DOI  :  10.1186/s12879-015-1208-1

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

来源: Springer

【 摘 要 】

BackgroundRecent 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.MethodsThe 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.ResultsTwo 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).ConclusionsThe 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】

CC BY   
© Kieran et al. 2015