title: Economic burden of hepatitis B virus-related diseases: evidence from iran.
abstract: BACKGROUND
  Hepatitis B infection is still the main cause of chronic liver disease in Iran, which is associated with significant economic and social costs.
  
  
  OBJECTIVE
  This study aimed to estimate the financial burden caused by CHB infection and its complications in Iran.
  
  
  METHODS
  Prevalence-based and bottom-up approaches were used to collect the data. Data on direct medical costs were extracted from outpatient medical records in a referral gastroenterology and hepatology research center, inpatient medical records in several major hospitals in Tehran and Shiraz in 2013, and the self-reports of specialists. Data on direct non-medical and indirect costs were collected based on the patients' self-reports through face-to-face interviews performed in the mentioned centers. To calculate the indirect costs, friction cost approach was used. To calculate the total cost-of-illness in Iran, the total cost per patient at each stage of the disease was estimated and multiplied by the total number of patients.
  
  
  RESULTS
  The total annual cost for the activate population of CHB patients and for those receiving treatment at various disease stages were respectively 450 million and 226 million dollars, with 64% and 70% of which allocated to direct costs respectively, and 36% and 30% to indirect costs respectively. The total direct costs alone for each group were respectively 1.17% and 0.6% of the total health expenditure. Furthermore, the cost spent on drugs encompasses the largest proportion of the direct medical cost for all stages of the disease.
  
  
  CONCLUSIONS
  According to the perspectives of payers, patients, and community, CHB infection can be considered as one of the diseases with a substantial economic burden; the disease, specifically in extreme cases, can be too expensive and costly for patients. Therefore, patients should be protected against more severe stages of the disease through proper treatment and early diagnosis.
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran ; Health Human Resource Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Khosro
authors.initials: K
authors.lastname: Keshavarz
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Kebriaeezadeh
authors.affiliation: Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Seyed Moayed
authors.initials: SM
authors.lastname: Alavian
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran ; Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Akbari Sari
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Abedin Dorkoosh
authors.affiliation: Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Iranian Blood Transfusion Organization, Tehran, IR Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Keshvari
authors.affiliation: Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Malekhosseini
authors.affiliation: Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Saman
authors.initials: S
authors.lastname: Nikeghbalian
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Shekoufeh
authors.initials: S
authors.lastname: Nikfar
keywords: CHB; Cost of Illness; Diseases