title: Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection.
abstract: Hepatitis C virus (HCV) infection increases total healthcare costs but the effect of the severity of liver disease associated with chronic hepatitis C (CHC) on healthcare costs has not been well studied. We analyzed the demographics, healthcare utilization, and healthcare costs of CHC patients in a large U.S. private insurance database (January, 2002 to August, 2010), with at least 1 year of baseline enrollment and 30 days of continuous follow-up. Patients were stratified by liver disease severity: noncirrhotic liver disease (NCD), compensated cirrhosis (CC), and endstage liver disease (ESLD), as defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) codes. Mean all-cause and HCV-related healthcare costs per-patient-per-month (PPPM) during follow-up (mean 634 days) are reported in 2010 U.S.$ from the payer's perspective. A total of 53,796 patients with CHC were included (NCD: 41,858 [78%]; CC: 3,718 [7%]; and ESLD: 8,220 [15%]). Mean all-cause PPPM healthcare costs were 32% and 247% higher for patients with CC and ESLD compared to those with NCD ($1,870 and $4,931 versus $1,420; P < 0.001) and were independent of age or comorbid conditions. Pharmacy, ambulatory, and inpatient care collectively accounted for 90% of NCD costs and 93% of CC and ESLD costs. The largest cost components were inpatient costs for those with ESLD (56%) and ambulatory costs for those with CC and NCD (37% and 36%, respectively). Overall, 56% of costs were HCV-related and this proportion increased with severity (46%, 57%, and 71% for patients with NCD, CC, and ESLD, respectively).
  
  
  CONCLUSIONS
  The direct healthcare costs associated with CHC are high, increase in association with the progression of liver disease, and are highest in those with ESLD.
authors.affiliation: Henry Ford Health System, Detroit, MI, USA. sgordon3@hfhs.org
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Pockros
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoop
authors.forename: Ami
authors.initials: A
authors.lastname: Buikema
authors.forename: David
authors.initials: D
authors.lastname: Nerenz
authors.forename: Fayez M
authors.initials: FM
authors.lastname: Hamzeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D016208:Databases, Factual; D016527:Drug Costs / Q000706:statistics & numerical data; D058625:End Stage Liver Disease / Q000191:economics* / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult
chemical_list: D000998:Antiviral Agents