title: Predictors of high healthcare resource utilization and liver disease progression among patients with chronic hepatitis C.
abstract: BACKGROUND
  Since hepatitis C virus therapy is typically prioritized for patients with more advanced disease, predicting which patients will progress could help direct scarce resources to those likely to benefit most. This study aims to identify demographics and clinical characteristics associated with high healthcare resource utilization (HRU) and liver disease progression among CHC patients.
  
  
  METHODS
  Using health insurance claims (January 2001-March 2013), adult patients with ≥2 CHC claims (ICD-9-CM: 070.44 or 070.54), and ≥6 months of continuous insurance coverage before and ≥36 months after the first CHC diagnosis were included. Patients with human immunodeficiency virus were excluded. Generalized estimating equations were used to identify the demographic and clinical characteristics of being in the 20% of patients with the highest HRU. Factors predicting liver disease progression were also identified.
  
  
  RESULTS
  In the study population (n = 4898), liver disease severity and both CHC- and non-CHC-related comorbidities and conditions were strong predictors of high healthcare costs, with odds ratios (ORs; 95% confidence interval [CI]) for ≥2 CHC-related and ≥2 non-CHC-related comorbidities/conditions of 2.78 (2.48-3.12) and 2.19 (1.76-2.72), respectively. CHC- and non-CHC-related comorbidities and conditions were also strong predictors of liver disease progression with ORs (95% CI) for ≥2 CHC-related and ≥2 non-CHC-related comorbidities and conditions of 2.18 (1.83-2.60) and 1.50 (1.14-1.97), respectively.
  
  
  CONCLUSIONS
  Potential inaccuracies in claims data, information or classification bias, and findings based on a privately insured population.
  
  
  CONCLUSIONS
  This study suggests that CHC patients with high healthcare resource utilization have a high level of comorbidity at baseline and also that non-CHC comorbidities and conditions are strong predictors of high HRU. Non-cirrhotic CHC patients with one or more comorbidities are at high risk of progressing to cirrhosis or end-stage liver disease.
authors.affiliation: a a Janssen Scientific Affairs , LLC , Titusville , NJ , USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: LaMori
authors.affiliation: a a Janssen Scientific Affairs , LLC , Titusville , NJ , USA.
authors.forename: Neeta
authors.initials: N
authors.lastname: Tandon
authors.affiliation: b b Groupe d'analyse , Ltée , Montréal , QC , Canada.
authors.forename: François
authors.initials: F
authors.lastname: Laliberté
authors.affiliation: b b Groupe d'analyse , Ltée , Montréal , QC , Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Germain
authors.affiliation: b b Groupe d'analyse , Ltée , Montréal , QC , Canada.
authors.forename: Dominic
authors.initials: D
authors.lastname: Pilon
authors.affiliation: b b Groupe d'analyse , Ltée , Montréal , QC , Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.affiliation: a a Janssen Scientific Affairs , LLC , Titusville , NJ , USA.
authors.forename: Avinash
authors.initials: A
authors.lastname: Prabhakar
mesh_terms: D000998:Antiviral Agents / Q000191:economics; D015897:Comorbidity; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000191:economics / Q000503:physiopathology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D019698:Hepatitis C, Chronic / Q000191:economics* / Q000503:physiopathology; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents
keywords: Cirrhosis severity; Comorbidities; End-stage liver disease; Healthcare costs; Healthcare utilizers