title: Economic burden associated with patients diagnosed with hepatitis C.
abstract: BACKGROUND
  New therapies for Hepatitis C virus (HCV) are under development that will augment pegylated interferon-alpha plus ribavirin to improve patient outcomes. Data documenting the incremental economic and health burden of patients with HCV relative to those who are not infected with HCV will be required to evaluate the comparative effectiveness of these new therapies.
  
  
  OBJECTIVE
  The objective of this study was to estimate the incremental impact of HCV infection on health care costs and risk of adverse health events.
  
  
  METHODS
  Paid claims data for commercially insured patients in the United States were used to identify 2 matched cohorts of 8861 patients with and without HCV infection. Propensity score matching was used to adjust for patient demographics, diagnostic mix, prior use, and drug profile. Patients with prior cirrhosis, liver cancer, or liver transplantation were excluded. Differences in the first postindex year associated with the diagnosis of an HCV infection were estimated for adverse event risk (logistic regression), costs (ordinary least square regression), and utilization counts (generalized linear models), controlling for patient demographics, prior use, comorbidity profile, and prescription drug profile.
  
  
  RESULTS
  The costs of treating patients infected with HCV and a matched sample not infected with HCV were $37,390 and $13,575, respectively. The incremental cost of HCV infection was estimated at +$23,406, primarily because of higher costs for ambulatory care (+$6531), hospital services (+$1827), and prescription drugs (+$6935). The presence of HCV was associated with a significantly higher risk of hospitalization (odds ratio [OR] = 2.5) and number of hospital admissions (+186%); depression (OR = 2.2); cirrhosis (OR = 65.8); hepatic cancer (OR = 28.1), and liver transplantation (OR = 46.1; P < 0.0001 for all estimates).
  
  
  CONCLUSIONS
  A diagnosis of HCV infection was correlated significantly with increased adverse event risk and increased health care costs. New alternative treatments are needed that are more efficacious and less burdensome for the patient. Limitations of this study are that only 1 year was used to screen for preexisting conditions and events and that paid claims data do not capture indirect HCV infection costs such as time lost from work.
authors.affiliation: School of Pharmacy, University of Southern California, Los Angeles, 90089-9004, USA. jmccombs@usc.edu
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: McCombs
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.forename: Janet
authors.initials: J
authors.lastname: Shin
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D015995:Prevalence; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a