title: Direct medical care costs among pegylated interferon plus ribavirin-treated and untreated chronic hepatitis C patients.
abstract: BACKGROUND
  Hepatitis C virus (HCV) is a common and expensive infectious disease. The current standard of care for HCV infection, pegylated interferon with ribavirin (PEG-RBV), is costly and has a significant adverse event profile.
  
  
  OBJECTIVE
  To quantify the direct economic burden of HCV infection and PEG-RBV treatment for HCV.
  
  
  METHODS
  Using a large administrative claims database, we evaluated the medical and prescription drug costs of patients with HCV from 2002 to 2007. A cohort of patients with PEG-RBV was 1:1 propensity score-matched to a cohort of untreated HCV patients. Multivariate models adjusted for demographic and clinical characteristics in evaluating the effect of PEG-RBV treatment on direct medical expenditure.
  
  
  RESULTS
  The matched analysis included 20,002 patients. PEG-RBV-treated patients had higher total direct medical costs ($28,547 vs. $21,752; P < 0.001), outpatient pharmacy costs ($17,419 vs. $2,900; P < 0.001), and outpatient physician visit costs ($894 vs. $787; P < 0.001), but lower inpatient costs ($3,942 vs. $9,543; P < 0.001) and emergency room costs ($366 vs. $505; P < 0.001). After multivariate adjustment, PEG-RBV use was associated with an additional $9,423 in total direct medical costs and an additional $12,244 in HCV-related total medical costs.
  
  
  CONCLUSIONS
  Total HCV-related medical costs are higher for treated than untreated patients, driven mostly by higher outpatient pharmacy costs, which outweigh higher HCV-related inpatient costs incurred by untreated patients.
authors: Stanford University School of Medicine, Stanford, CA, USA.
authors: M
authors: M
authors: Solomon
authors: M
authors: M
authors: Bonafede
authors: K
authors: K
authors: Pan
authors: K
authors: K
authors: Wilson
authors: C
authors: C
authors: Beam
authors: P
authors: P
authors: Chakravarti
authors: B
authors: B
authors: Spiegel
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D017281:Cost of Illness; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007297:Inpatients; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a