title: [Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].
abstract: OBJECTIVE
  To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen.
  
  
  METHODS
  Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden.
  
  
  RESULTS
  On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the sum total was 16:1. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 285.3%, and 75.4% for annual household income. Furthermore, proportions of direct costs accounted for annual patient income and annual household income were 108.1% and 28.6%. The total annual indirect cost per person was 8123.38 Yuan for patients of all hepatitis B-related diseases, while 7134.63 Yuan for caregivers. Corresponding work-loss days were 55.74 days for patients and 19.83 days for caregivers. Based on multiple linear stepwise regression analysis, age of patients was a common influencing factor to all kinds of costs. Other factors were as follows: complicated with other diseases, antiviral medication, monthly household income and self-medications.
  
  
  CONCLUSIONS
  The economic burden of hepatitis B-related diseases was substantial for patients and their families. All costs tended to increase with the severity of disease. The direct costs were larger than the indirect costs. And the direct medical costs were more than the direct ones. Indirect costs based on patients were larger than the ones of caregivers.
authors.affiliation: College of Public Nealth, Zhengzhou University, Zhengzhou 450001, China.
authors.forename: Sen
authors.initials: S
authors.lastname: Liang
authors.forename: Shun-xiang
authors.initials: SX
authors.lastname: Zhang
authors.forename: Qi-shan
authors.initials: QS
authors.lastname: Ma
authors.forename: He-wei
authors.initials: HW
authors.lastname: Xiao
authors.forename: Qiu-ying
authors.initials: QY
authors.lastname: Lü
authors.forename: Xu
authors.initials: X
authors.lastname: Xie
authors.forename: Shu-jiang
authors.initials: SJ
authors.lastname: Mei
authors.forename: Dong-sheng
authors.initials: DS
authors.lastname: Hu
authors.forename: Bo-ping
authors.initials: BP
authors.lastname: Zhou
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.forename: Jing-fang
authors.initials: JF
authors.lastname: Chen
authors.forename: Fu-qiang
authors.initials: FQ
authors.lastname: Cui
authors.forename: Fu-zhen
authors.initials: FZ
authors.lastname: Wang
authors.forename: Xiao-feng
authors.initials: XF
authors.lastname: Liang
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006509:Hepatitis B / Q000191:economics* / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics* / Q000453:epidemiology; D008113:Liver Neoplasms / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires