title: Incidence and cost of treatment-emergent comorbid events in insured patients with chronic hepatitis C virus infection: a retrospective cohort study.
abstract: BACKGROUND
  Treatment-emergent comorbid events (TECs) are common In patients initiating treatment with pegylated interferon alpha (PEG-IFN-alfa) and ribavirin for chronic hepatitis C virus (HCV) infection. The purpose of this study was to estimate the incidence and incremental cost of these events.
  
  
  METHODS
  In a retrospective cohort analysis of healthcare claims, we studied patients with HCV who were newly treated with PEG-IFN-alfa/ribavirin between 2006 and 2008. TECs were defined by new medical/pharmacy claims for predefined conditions in the 12 months after treatment initiation. The net incremental cost of the TECs was the difference between baseline and follow-up costs for these comorbidities and their treatment, excluding PEG-IFN-alfa/ribavirin costs.
  
  
  RESULTS
  Of 3,795 newly treated patients, 1,269 (mean age 50.2, 36.2% female) met the selection criteria. New TECs were common, with 61.6% of patients having ≥1 event. Anemia was identified in 29.2% of patients, fatigue in 16.4%, depression in 11.5%, and neutropenia in 11.0%. The mean incremental cost for the predefined TEC in the postindex period was $6,377 ($2,782 for medical and $3,595 for pharmacy claims).
  
  
  CONCLUSIONS
  In an insured US cohort with chronic HCV infection, TECs with PEG-IFN-alfa/ribavirin were common and increased costs by approximately $6,000 per treated patient. This estimate may be conservative because it excludes indirect costs. Costs might increase with new regimens that include a protease inhibitor because additional TECs may be expected. Better-tolerated therapies that reduce the financial burden on the healthcare system and improve patient experience are needed.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Sapra
authors.forename: Eunice
authors.initials: E
authors.lastname: Chang
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S, Beverly Drive, Suite 404, Beverly Hills, CA, USA. mbroder@pharllc.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
authors.forename: Gilbert
authors.initials: G
authors.lastname: L'Italien
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000191:economics; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D016898:Interferon-alpha / Q000009:adverse effects* / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects* / Q000191:economics
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin