title: Hepatitis C virus therapy is associated with lower health care costs not only in noncirrhotic patients but also in patients with end-stage liver disease.
abstract: BACKGROUND
  The effect of anti-viral treatment on downstream costs for hepatitis C virus (HCV)-infected patients is unknown.
  
  
  OBJECTIVE
  To evaluate follow-up costs in patients with chronic HCV, stratified by liver disease severity.
  
  
  METHODS
  Using a US private insurance database, mean all-cause per-patient-per-month (PPPM) US (2010) medical costs were calculated for HCV-infected persons who did and did not receive anti-HCV treatment between January 2002 and August 2010. Analysis was stratified by liver disease severity [noncirrhotic disease (NCD), compensated cirrhosis (CC) or end-stage liver disease (ESLD)] defined by ICD-9 and CPT codes.
  
  
  RESULTS
  A total of 33 309 patients were included (78% NCD, 7% CC and 15% ESLD); 4111 individuals (12%) received anti-HCV treatment during the 2-year baseline period. Mean PPPM follow-up health care costs were significantly lower among treated patients with NCD ($900 vs. $1378 in untreated patients, P < 0.001) and ESLD ($3634 vs. $5071, P < 0.001) groups but not in the CC group ($1404 vs. $1795, P < 0.071; t-test). In a multivariable model adjusted for demographic characteristics, comorbidities, index date and geographical region, incremental cost ratios for total health care costs differed significantly (P < 0.001) between treated and untreated patients in the NCD and ESLD groups but not in the CC group. From this model, mean PPPM total health care costs between treated and untreated patients were $885 and $1370 in the NCD, $1369 and $1802 in the CC, and $3547 and $5137 in the ESLD groups, respectively.
  
  
  CONCLUSIONS
  Anti-HCV therapy was associated with lower follow-up US health care costs, and these savings were independent of baseline patient comorbidities and stage of disease.
authors: Henry Ford Health System, Detroit, MI, USA. sgordon3@hfhs.org
authors: S C
authors: SC
authors: Gordon
authors: F M
authors: FM
authors: Hamzeh
authors: P J
authors: PJ
authors: Pockros
authors: R S
authors: RS
authors: Hoop
authors: A R
authors: AR
authors: Buikema
authors: E J
authors: EJ
authors: Korner
authors: N A
authors: NA
authors: Terrault
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D004268:DNA-Binding Proteins; D016208:Databases, Factual; D029721:Drosophila Proteins; D058625:End Stage Liver Disease / Q000191:economics* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics / Q000473:pathology; D008107:Liver Diseases / Q000191:economics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004268:DNA-Binding Proteins; D029721:Drosophila Proteins; C076001:unk protein, Drosophila
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