title: Costs and absence of HCV-infected employees by disease stage.
abstract: OBJECTIVE
  Quantify the costs and absenteeism associated with stages of the Hepatitis C virus (HCV).
  
  
  METHODS
  Retrospective analysis of the HCMS integrated database from multiple geographically diverse, US-based employers with employee information on medical, prescription, and absenteeism claims.
  
  
  METHODS
  Employee data were extracted from July 2001-March 2013. Employees with HCV were identified by ICD-9-CM codes and classified into disease severity cohorts using diagnosis/procedure codes assigning the first date of most severe claim as the index date. Non-HCV employees (controls) were assigned random index dates. Inclusion required 6-month pre-/post-index eligibility. Medical, prescription, and absenteeism cost and time were analyzed using two-part regression (logistic/generalized linear) models, controlling for potentially confounding factors. Costs were inflation adjusted to September 2013.
  
  
  RESULTS
  All direct costs comparisons were statistically significant (p ≤ 0.05) with mean medical costs of $1813 [SE = $3] for controls (n = 727,588), $4611 [SE = $211] for non-cirrhotic (n = 1007), $4646 [SE = $721] for compensated cirrhosis (CC, n = 87), $12,384 [SE = $1122] for decompensated cirrhosis (DCC, n = 256), $33,494 [SE = $11,753] for hepatocellular carcinoma (HCC, n = 17) and $97,724 [SE = $32,437] for liver transplant (LT, n = 19) cohorts. Mean short-term disability days/costs were significantly greater for the non-cirrhotic (days = 2.03 [SE = 0.36]; $299 [SE = $53]), DCC (days = 6.20 [SE = 1.36]; $763 [SE = $169]), and LT cohorts (days = 21.98 [SE = 8.21]; $2537 [SE = $972]) compared to controls (days = 1.19 [SE = 0.01]; $155 [SE = $1]). Mean sick leave costs were significantly greater for non-cirrhotic ($373 [SE = $22]) and DCC ($460 [SE = $54]) compared to controls ($327 [SE = $1]).
  
  
  CONCLUSIONS
  Employees with HCV were shown to have greater direct and indirect costs compared to non-HCV employee controls. Costs progressively increased in the more severe HCV disease categories. Slowing or preventing disease progression may avert the costs of more severe liver disease stages and enable employees with HCV to continue as productive members of the workforce.
authors.affiliation: a a AbbVie, Global Health Economics & Outcomes Research , North Chicago , IL , USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Baran
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Samp
authors.forename: David R
authors.initials: DR
authors.lastname: Walker
authors.forename: James E
authors.initials: JE
authors.lastname: Smeeding
authors.forename: Jacob W
authors.initials: JW
authors.lastname: Young
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Kleinman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Brook
mesh_terms: D000041:Absenteeism; D015897:Comorbidity; D017281:Cost of Illness; D004526:Efficiency; D005252:Fees, Pharmaceutical / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006526:Hepatitis C / Q000150:complications / Q000191:economics*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017059:Models, Econometric; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018582:Sick Leave / Q000191:economics*; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Absenteeism; Cirrhosis; Costs of care/Healthcare expenditures; Hepatitis; Hepatocellular carcinoma; Liver-transplant; Presenteeism