Henry Ford Health System, Detroit, MI, USA. email@example.com.
HCV infection increases total health care costs but the effect of the severity of liver disease associated with chronic hepatitis C (CHC) on health care costs has not been well studied. We analyzed the demographics, health care utilization and health care costs of CHC patients in a large US private insurance database (January, 2002-August, 2010), with at least one year of baseline enrollment and 30 days of continuous follow-up. Patients were stratified by liver disease severity: non-cirrhotic liver disease (NCD), compensated cirrhosis (CC), and end-stage liver disease (ESLD), as defined by the International Classification of Diseases (ICD-9) codes. Mean all-cause and HCV-related health care costs per-patient-per-month (PPPM) during follow-up (mean 634 days) were reported in 2010 US$ from the payer's perspective. A total of 53,796 patients with CHC were included [NCD: 41,858 (78%); CC: 3,718 (7%); and ESLD: 8,220 (15%)]. Mean all-cause PPPM health care costs were 32% and 247% higher for patients with CC and ESLD compared to those with NCD ($1870 and $4931 vs $1420; p<.001) and were independent of age or co-morbid conditions. Pharmacy, ambulatory, and inpatient care collectively accounted for 90% of NCD costs and 93% of CC and ESLD costs. The largest cost components were inpatient costs for those with ESLD (56%) and ambulatory costs for those with CC and NCD (37% and 36%, respectively). Overall, 56% of costs were HCV-related and this proportion increased with severity (46%, 57% and 71% for patients with NCD, CC and ESLD, respectively). Conclusion: The direct health care costs associated with CHC are high, increase in association with the progression of liver disease and are highest in those with ESLD.