Hepatitis C in the era of direct-acting antivirals: real-world costs of untreated chronic hepatitis C; a cross-sectional study.
BACKGROUND
Recent advances in Hepatitis C therapeutics offer the possibility of cure but will be expensive. The cost of treatment may be partially offset by the avoidance of advanced liver disease. We performed a micro-costing study of the ambulatory healthcare utilisation of patients with Hepatitis C supplemented with inpatient diagnosis related group costs.


METHODS
The staff utilisation costs associated with a Hepatitis C ambulatory visit were measured and combined with the costs of investigations to establish a mean cost per consultation. An annualised estimate of cost was produced by multiplying this by the number of consultations accessed, stratified by degree of liver impairment. Inpatient costs were established by identifying the number of inpatient episodes and multiplying by Irish diagnosis related group costs. Non-parametric bootstrapping was performed to derive mean and 95%CI values.


RESULTS
Two hundred and twenty-five patients were identified. The cost of an outpatient medical review was €136 (€3.60 SD). The cost of a Hepatitis C nursing review was €128 (€7.30 SD). The annual mean costs of care were as follows (95%CI): Mild €398 (€336, €482), Moderate €417(€335, €503), Compensated cirrhosis €1790 (€990, €3164), Decompensated cirrhosis €8302 (€3945, €14,637), Transplantation Year 1 €137,176 (€136,024, €138,306), Transplantation after Year 1 €5337 (€4942, €5799), Hepatocellular carcinoma €21,992 (€15,222, €29,467), Sustained virological response €44 (€16, €73).


CONCLUSIONS
The direct medical cost associated with Hepatitis C care in Ireland is substantial and increases exponentially with progression of liver disease. The follow-up costs of patients with a sustained virological response in this cohort were low in comparison to patients with chronic infection.
Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland. jkieran@tcd.ie.|National Centre for Pharmacoeconomics, St. James Hospital, Dublin, Ireland. jkieran@tcd.ie.
Jennifer Ann
JA
Kieran
Department of Hepatology, St. James Hospital, Dublin, Ireland. snorris@stjames.ie.|School of Medicine, Trinity College Dublin, Dublin, Ireland. snorris@stjames.ie.
Suzanne
S
Norris
National Centre for Pharmacoeconomics, St. James Hospital, Dublin, Ireland. aoleary@stjames.ie.|School of Pharmacy, Royal College of Surgeons of Ireland, Dublin, Ireland. aoleary@stjames.ie.
Aisling
A
O'Leary
MACSI and Health Research Institute, University of Limerick, Limerick, Ireland. cathal.walsh@ul.ie.
Cathal
C
Walsh
Liver Unit, St. Vincent's University Hospital, Dublin, Ireland. raphael.merriman@ucsf.edu.
Raphael
R
Merriman
Liver Unit, St. Vincent's University Hospital, Dublin, Ireland. diarmaidhoulihan@hotmail.com.
D
D
Houlihan
Liver Unit, St. Vincent's University Hospital, Dublin, Ireland. aiden.mccormick@svuh.ie.
P Aiden
PA
McCormick
Department of Hepatology, St. James Hospital, Dublin, Ireland. smckiernan@stjames.ie.|School of Medicine, Trinity College Dublin, Dublin, Ireland. smckiernan@stjames.ie.
Susan
S
McKiernan
Department of Genitourinary Medicine and Infectious Diseases, St. James Hospital, Dublin, Ireland. cbergin@stjames.ie.|School of Medicine, Trinity College Dublin, Dublin, Ireland. cbergin@stjames.ie.
Colm
C
Bergin
Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland. mbarry@stjames.ie.|National Centre for Pharmacoeconomics, St. James Hospital, Dublin, Ireland. mbarry@stjames.ie.
Michael
M
Barry
D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000821:virology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics; D006801:Humans; D007494:Ireland; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000821:virology; D008113:Liver Neoplasms / Q000191:economics / Q000821:virology; D016031:Liver Transplantation / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged
D000998:Antiviral Agents