title: Estimation of direct medical cost related to the management of chronic hepatitis C and its complications in South Korea.
abstract: BACKGROUND
  This study aimed to estimate the direct medical costs of managing chronic hepatitis C (CHC) and its complications based on health-care resources in South Korea.
  
  
  METHODS
  The study design was multicenter, retrospective, non-interventional, and observational. Between September 2013 and April 2014, health-care resource data from patients chronically infected with hepatitis C virus, regardless of genotype, were collected from 8 institutions, including data related to outpatient management, emergency care, and hospitalization. The observation period was between January 2011 and December 2012. The disease state was classified as CHC, compensated cirrhosis (CC), decompensated cirrhosis (DC), or hepatocellular carcinoma (HCC).
  
  
  RESULTS
  A total of 445 patients were recruited and mean age was 60.1 ± 12.3 years. Among 155 patients with reported outcomes of antiviral therapy, 107 (69%) had sustained virologic response (SVR). The rate of patients who did not receive antiviral therapy was 52.8% (n = 235). The distribution of disease state was CHC in 307 patients (69.0%), CC in 75 (16.9%), HCC in 45 (10.1%), and DC in 18 (4.0%). All direct medical costs, whether reimbursed or nonreimbursed by the National Health Insurance System, were included. After excluding patients whose observational period was <1 month for each disease status, the mean costs per month increased as disease state progressed (CHC: 77 ± 80 USD; CC: 98 ± 94 USD; DC: 512 ± 1115 USD; HCC: 504 ± 717 USD). The mean total costs per person were 3590 ± 8783 USD, and approximately 72% of patients were reimbursed. When 44 patients with an observation period <1 month were excluded, the mean medical costs per month for patients with CHC who achieved SVR (n = 69) were significantly lower than for those (n = 215) who did not (42 ± 16 vs 79 ± 83 USD, P < 0.001). The cost also tended to be lower for patients with CC with SVR (n = 8) than for those without SVR (n = 70; 48 ± 20 vs 95 ± 96 USD, P = 0.177). The cost of antiviral therapy (pegylated interferon and ribavirin) corresponded to 19.0% of total medical costs and 53.7% of prescription/pharmacy.
  
  
  CONCLUSIONS
  The direct medical costs increased as disease state progressed from CHC to cirrhosis or HCC. The achievement of SVR by antiviral therapy would decrease the costs.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine Pusan National University School of Medicine Seoul National University College of Medicine Seoul Metropolitan Government Boramae Medical Center University of Ulsan College of Medicine, Asan Medical Center The Catholic University College of Medicine National Health Insurance Hospital Merck Sharp & Dohme Korea Ltd Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Sung Hwi
authors.initials: SH
authors.lastname: Hong
authors.forename: Danbi
authors.initials: D
authors.lastname: Lee
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Choi
authors.forename: Ilsu
authors.initials: I
authors.lastname: Kim
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Paik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000191:economics / Q000453:epidemiology; D008113:Liver Neoplasms / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D000072230:Sustained Virologic Response; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a