title: The societal burden of chronic liver diseases: results from the COME study.
abstract: OBJECTIVE
  Chronic liver diseases (CLDs) impose a significant socioeconomic burden on patients and the healthcare system, but to what extent remains underexplored. We estimated costs and health-related-quality-of-life (HRQoL) among patients with CLDs at different stages and with different aetiologies.
  
  
  METHODS
  A cost-of-illness study was conducted. Direct costs, productivity loss and HRQoL were estimated in patients with chronic hepatitis, cirrhosis hepatocellular carcinoma (HCC) or where orthotopic liver transplantation (OLT) had been performed, for hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, or in those with liver disease from other causes. Patients were retrospectively observed for 6 months. The societal perspective was adopted to calculate costs.
  
  
  RESULTS
  In total, 1088 valid patients (median age=59.5 years, 60% men) were enrolled. 61% had chronic hepatitis, 20% cirrhosis, 8% HCC and 12% underwent OLT. HCV infection was identified in 52% and HBV infection in 29% of the patients. Adjusted mean direct costs increased from <€200/patient-month in HCV-infected patients with hepatitis to >€3000/patient-month in HBV infected patients with OLT. Antiviral treatment was the cost driver in patients with hepatitis, while hospital costs were the driver in the other subgroups. Absenteeism increased from HBV-infected patients with hepatitis (0.7 day/patient-month) to patients with OLT with other aetiologies (3.7 days/patient-month). HRQoL was on average more compromised in cirrhosis and patients with HCC, than in hepatitis and patients with OLT. HBV-infected patients generated higher direct costs, patients with other aetiologies generated the highest productivity loss and HCV-infected patients reported the worst HRQoL levels.
  
  
  CONCLUSIONS
  The present study can be considered a benchmark for future research and to guide policies aimed at maximising the cost-effective of the interventions.
authors.affiliation: Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy ; Fondazione CHARTA , Milano , Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Scalone
authors.affiliation: Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.affiliation: Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy ; Fondazione CHARTA , Milano , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ciampichini
authors.affiliation: Organizzazione di pazienti-EpaC ONLUS.
authors.forename: Ivan
authors.initials: I
authors.lastname: Gardini
authors.affiliation: Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy ; Unità di Malattie Infettive Tropicali e Epatologia Dipartimento di Scienze Clinico-Chirurgiche Diagnostiche e Pediatriche , Università degli Studi di Pavia , Italy ; Dipartimento Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia , Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bruno
authors.affiliation: Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Pasulo
authors.affiliation: Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Lucà
authors.affiliation: Fondazione CHARTA , Milano , Italy ; Istituto di Management-Management e Innovation (MAIN) Scuola Superiore Sant'Anna , Pisa , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Gastroenterologia. Dipartimento di Medicina Clinica e Chirurgia. Scuola di Medicina , Università degli Studi di Napoli Federico II , Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Gaeta
authors.affiliation: Gastroenterologia. Dipartimento di Medicina Clinica e Chirurgia. Scuola di Medicina , Università degli Studi di Napoli Federico II , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Del Prete
authors.affiliation: Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.affiliation: Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy ; Fondazione CHARTA , Milano , Italy.
authors.forename: Lorenzo Giovanni
authors.initials: LG
authors.lastname: Mantovani
keywords: CHRONIC LIVER DISEASE; HEALTH ECONOMICS; QUALITY OF LIFE