Patient time costs and out-of-pocket costs in hepatitis C.
BACKGROUND
Hepatitis C virus (HCV) infection is associated with substantial costs to patients, their caregivers and society.


OBJECTIVE
We evaluated time costs (time spent seeking healthcare) and out-of-pocket (OOP) costs for patients with HCV and their caregivers.


METHODS
We measured costs for 738 HCV outpatients in a tertiary-care clinic using a patient-completed questionnaire. Time and OOP costs were compared across disease stages and sociodemographic categories. We examined the association between cost and disease stage using linear regression adjusting for age, gender, marital status, education, income and Index of Coexistent Disease (ICED) comorbidity score. Costs were expressed in 2007 Canadian dollars.


RESULTS
The mean annual time cost per patient was $2136 (98 h), and ranged from $281 (18 h) in individuals who had cleared the virus to $9416 in transplant recipients (420 h). Caregiver costs were reported in 10% of patients. The mean annual OOP cost per patient was $1326. Patients receiving active treatment and those with late-stage disease spent $2500-2800 per year on HCV-related healthcare, approximately 7% of their annual income. Patients who had cleared the virus had the lowest time and OOP costs. Low income and unemployed patients had higher costs.


CONCLUSIONS
In HCV-infected individuals, OOP and time costs represent a significant economic burden and fall disproportionately upon those least able to afford them. The lower cost burden among those who were successfully treated suggests that wider use of antiviral therapy may reduce economic burden in addition to improving health outcomes.
Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
Carole A
CA
Federico
Priscilla C
PC
Hsu
Mel
M
Krajden
Eric M
EM
Yoshida
Karen E
KE
Bremner
Alan A
AA
Weiss
Frank H
FH
Anderson
Murray D
MD
Krahn
D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D001955:British Columbia / Q000453:epidemiology; D017028:Caregivers / Q000191:economics*; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D019698:Hepatitis C, Chronic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008107:Liver Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013997:Time Factors
D000998:Antiviral Agents