January 8, 2013

HCV Screening Cost Effective vs Direct HCV Patient Care Costs

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patients with HCV infection have higher direct healthcare costs compared with patients who do not have HCV infection......"the costs associated with the care of patients with CHC are substantial and are driven largely by disease severity......the costs of screening and treatment must be offset by the costs of ignoring these options and allowing chronic HCV disease to progress from NCD to CC and ESLD.........the direct costs associated with chronic HCV are considerable, averaging over $24,000 annually for all patients and $60,000 for those with advanced liver disease........birth-cohort screening of all patients born between 1945 and 1965 is cost-effective, averaging $2,874 per new case identified.......There is a large cohort of aging patients who were infected between 1960 and 1980,3 with a resultant increase in the current number of patients with compensated cirrhosis (CC) and, subsequently, endstage liver disease (ESLD). Between 1996 and 2006 the proportion of patients with HCV-related cirrhosis increased from 9% to 19%, and the prevalence of decompensated cirrhosis increased from 5% to 11%.4 The prevalence of hepatocellular carcinoma (HCC) and HCV-related mortality has also increased considerably......treatment of HCC and liver transplantation are undoubtedly associated with very high healthcare costs......Our estimates of the annual cost of care for patients with ESLD and either HCC ($112,537) or OLT ($145,045)......The subgroup analysis of patients with ESLD demonstrates that the cost of caring for patients with OLT is ~3 times greater than in patients without OLT and the cost of caring for patients with HCC is approximately twice that of caring for patients without HCC......The stepwise increase in direct healthcare costs with increasing liver disease severity highlights the imminent crisis that CHC infection poses in an aging population for the U.S. healthcare system. The proportion of patients with cirrhosis and ESLD, the incidence of HCC, and the rate of liver-related deaths are all increasing.4, 9, 17, 18 Moreover, the greatest increase in the incidence of HCC is occurring in those aged 45 to 60 years, and approximately three-quarters of HCC deaths attributable to HCV infection is occurring between the ages of 45 and 64 years.8, 18 The mean age of patients with NCD, CC, and ESLD in our analysis falls within these ranges."

Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection - "Mean PPPM [per-month-per patient] all-cause healthcare costs were 32% and 247% higher for patients with CC and ESLD" - (12/03/12) Hepatology Nov 2012

"The proportion of patients with cirrhosis and ESLD, the incidence of HCC, and the rate of liver-related deaths are all increasing.4, 9, 17, 18 Moreover, the greatest increase in the incidence of HCC is occurring in those aged 45 to 60 years, and approximately three-quarters of HCC deaths attributable to HCV infection is occurring between the ages of 45 and 64 years"

"our data intuitively demonstrate that, in the future, the costs of screening and treatment must be offset by the costs of ignoring these options and allowing chronic HCV disease to progress from NCD to CC and ESLD. We have clearly shown that the direct costs associated with chronic HCV are considerable, averaging over $24,000 annually for all patients and $60,000 for those with advanced liver disease. A recent study showed that birth-cohort screening of all patients born between 1945 and 1965 is cost-effective, averaging $2,874 per new case identified. If the costs of treatment are included, this adds $15,700 per quality-adjusted life-year (QALY) assuming peginterferon plus ribavirin is used, or $35,700 per QALY saved assuming that a protease inhibitor is used in combination with peginterferon plus ribavirin.29 We have shown that the current cost of HCV disease management would likely offset these expenses."

"In conclusion, this retrospective analysis of a medical and pharmacy claims database demonstrates that the direct healthcare costs associated with CHC infection are high, increase in association with the progression of liver disease, and are highest in those with ESLD. Given the increasing age and disease severity, and the low rate of awareness of infection status in patients with CHC, priority should be given to identifying and treating patients with this disease. Early intervention has the potential to avoid healthcare costs associated with progressive liver disease."

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