title: The economic burden of advanced liver disease among patients with hepatitis C virus: a large state Medicaid perspective.
abstract: BACKGROUND
  Chronic hepatitis C virus (HCV) may progress to advanced liver disease (ALD), including decompensated cirrhosis and/or hepatocellular carcinoma (HCC). ALD can lead to significant clinical and economic consequences, including liver transplantation. This study evaluated the health care costs associated with ALD among HCV infected patients in a Medicaid population.
  
  
  METHODS
  Using Florida Medicaid claims data, cases were patients with at least 1 diagnosis of HCV or prescription therapy for HCV (ribavirin plus interferon, peginterferon, or interferon alfacon-1) prior to an incident ALD-related diagnosis ("index event") between 1999 and 2007. ALD-related conditions included decompensated cirrhosis, HCC, or liver transplant. A cohort of HCV patients without ALD (comparison group subjects) were matched 1-to-1 based on age, sex, and race. Baseline and follow-up were the 12 months prior to and following index, respectively; with both periods allowing for a maximum one month gap in eligibility. For both case and comparison patient cohorts, per-patient-per-eligible month (PPPM) costs were calculated as total Medicaid paid amount for each patient over their observed number of eligible months in follow-up, divided by the patient's total number of eligible months. A generalized linear model (GLM) was constructed controlling for age, race, Charlson score, alcoholic cirrhosis, and hepatitis B to explore all-cause PPPM costs between study groups. The final study group included 1,193 cases and matched comparison patients (mean age: 49 years; 45% female; 54% white, 23% black, 23% other).
  
  
  RESULTS
  The majority of ALD-related diagnoses were for decompensated cirrhosis (92%), followed by HCC (6%) and liver transplant (2%). Cases had greater comorbidity (mean Charlson score: 3.1 vs. 2.3, P < 0.001). All-cause inpatient use up to 1-year following incident ALD diagnosis was significantly greater among cases with ALD (74% vs. 27%, P < 0.001). In the GLM, cases had 2.39 times greater total adjusted mean all-cause PPPM costs compared to the comparison group ($4,956 vs. $1,735 respectively; P < 0.001). Among cases, mean total unadjusted ALD-related costs were $1,356 PPPM, which were largely driven by inpatient costs ($1,272).
  
  
  CONCLUSIONS
  Our results suggest that among patients diagnosed with HCV, the incremental costs of developing ALD are substantial, with inpatient stays as the main driver of these increased costs.
authors.affiliation: Boston Health Economics, Inc, 20 Fox Road, Waltham, MA 02451, USA. jmenzin@bhei.com
authors.forename: Joseph
authors.initials: J
authors.lastname: Menzin
authors.forename: Leigh Ann
authors.initials: LA
authors.lastname: White
authors.forename: Christine
authors.initials: C
authors.lastname: Nichols
authors.forename: Baris
authors.initials: B
authors.lastname: Deniz
mesh_terms: D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D005260:Female; D005431:Florida / Q000453:epidemiology; D006265:Health Care Coalitions / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008107:Liver Diseases / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D016031:Liver Transplantation / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents