Chronic Hepatitis C virus (HCV) affects about 3 million people in the United States. Many patients contracted the disease in the 1970s before testing and safe needle-sharing practices were widespread. As this population ages, experts have predicted an increasing impact on the healthcare system.
To understand how HCV outcomes are evolving, researchers, led by William C. Grant, Ph.D. of Duke University, analyzed hospitalizations, outpatient trends, and prescription drug data. They examined hospitalization trends for HCV-related and liver-related admissions from 1994 through 2001 using the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. They tracked HCV-related physicians' visits from 1996 to 2002. They also gathered data on spending for interferon-ribavirin combination therapy between 1998 and 2000 from the Verispan Source Prescription Audit.
The researchers determined that HCV-related hospitalizations, hospital days, total charges, and deaths increased by more than 20 percent per year, three times higher than for all-cause hospitalizations. "The growth patterns were most striking for patients in their forties and fifties," the authors report. Patients in this age group spent more time in the hospital, incurred greater costs, and died more frequently than patients in other age groups. Physician office visits by HCV patients also increased by 36 percent each year. And spending on HCV drug therapy rose dramatically between 1998 and 2000, from $78 per $100,000 in new prescriptions to $259.
"The study documents accelerating use of healthcare resources by patients with HCV," the authors report, with average annual increases of 25 to 35 percent for the primary outcomes of interest, "indicating that the future burden of HCV infection will match and may exceed analysts' forecasts," they say. Their findings corroborate existing concerns over worsening health as HCV patients grow older.
The researchers also noted interesting disparities in HCV progression by gender, with slower disease progression among women. HIV-HCV co-infected patients, and children with HCV are two groups deserving further study.
The authors performed sensitivity analyses to address the possibility of underreported HCV incidence, which remains an important limitation of this study. Still, they conclude, "our findings highlight the urgency concerning HCV outcomes. Across the United States, health care providers are using tremendous amounts of resources for HCV care. As patients continue to age and disease burden progresses, suboptimal decisions regarding HCV treatments will bring increasing opportunity costs for the health care system and society."
Article: "Trends in Health Care Resource Use for Hepatitis C Virus Infection in the United States," William C. Grant, Ravi R. Jhaveri, John G. McHutchison, Kevin A. Schulman, and Teresa L. Kauf, Hepatology; December 2005; (DOI: 10.1002/hep.20941)
Journal
Hepatology