iconstar paper   Hepatitis C Articles (HCV)  
Back grey arrow rt.gif
HCV Economics 101
  Reported by Jules Levin
HCV Economics -studies show:
----Screening is Cost-Effective;
----HCV+ Die 15 Years Sooner (new study- NYC Study);
-----in NYC new study - number reported of HCV among HIV/HCV connected MSM has tripled from 7% to 24%;
----HCC (liver cancer), hepatocelluar carcinoma rates doubled;
-----37% of HCV+ are Hospitalized & this rate Doubles for African-Americans vs Whites;
-----HCV Reported by Boston Hospital as the #1 Cause of Death in HIV+;
----HCV Patient Costs Are Double Those for HCV-neg;
----prevalence of advanced liver disease & their costs will continue to increase, as will the corresponding healthcare costs, by 2030, compensated cirrhosis cases will account for 37% of all prevalent cases, The HCV compensated cirrhotic population is projected to peak in 2015, while the decompensated cirrhotic population will peak in 2019"
------new therapies ... .if the number of treated patients is doubled ... .and the average SVR is increased to 70%, the 2030 prevalent population is projected to be less than 100,000 cases..... substantially reduce HCV infection in the US through active management."
Economics of HCV alone, aside from everything else, reflect the benefit for screening & providing good care:

As more HCV infected people progress to advanced liver disease, we project these serious conditions to generate a rapidly growing portion of medical costs for HCV-infected people over the next 5 to 10 years, and lead to a dramatic increase in costs over the next 20 years. In the absence of improved and accessible treatments that can alter the progression of disease, payers, especially Medicare, will feel the impact of a baby boomers' advanced liver disease epidemic." If not tested, receiving care and treatment ultimately a person with advanced disease becomes an expensive cost to the healthcare system beyond the cost of initial diagnosis, care & treatment. The cost for a patient with advanced disease has been figured in a number of studies. The costs for advanced disease include very costly hospitalizations, perhaps a liver transplant, and as that patient moves towards & through various stages of advanced disease & then end stage liver disease, it is very costly to the State & City as in the case of patients on medicaid & medicare that patient comes a public expense & burden. It is estimated in national scope that in about 16 years the total number of patients with advanced liver disease ail be 4 times greater than it is today, total overall healthcare costs for these patients is projected to increase 2.5 times from $30 billion to over $85 billion, Medicare associated costs will increase 6 times, its estimated the burden to Medicare will increase because a significant number of these patients have had HCV for 20-30 years are aging into Medicare - the proportion of burden increase to medicare is estimated to increase from 12% to 39%.
Hospitalization among Persons with Chronic Hepatitis C Virus Infection in the United States: The Chronic Hepatitis Cohort Study (CHeCS), 2006-2010 (37% of HCV+ hospitalized; African-Americans have double the rate vs whites)- (10/11/13)
HCV+ die 15 years sooner -
- if not HCV-infected average age of death is 78.....if HCV-infected 59 & if HCV/HIV connected 52. #1 Cause of death among HCV/HIV Coinfected is IDU-Drug Related, #2 liver cancer, among HCV mono-infects #1 is liver cancer, #2 IDU-drug related....BUT death rates due to IDU-drugs have decreased a lot & death due to hepatitis has increased a lot(see Figure 2).....53% of deaths in HCV/HIV connected is due to HCV....over half of deaths in 18-25 yr olds in this NYC Study are due to IDU-drugs.
3 studies just reported at the conference ID Week in San Francisco reported what has been reported previously in studies that HCV+ individuals die more quickly, by 15 years in this study in NYC, and more often have extra-hepatic diseases like cancers, diabetes etc, compared to HCV-neg individuals. Thus, the economic burden to the healthcare system & thus to the city & state is not even totally measured in HCV-related costs because when a patient's costs for cancer or diabetes, the death & care costs, are not reported to be due to HCV.
http://www.natap.org/2013/IDSA/IDSA_44.htm.......HCV Mortality Rate 12 times Higher in HCV+ vs HCV-neg, average age 59 vs 74 NATIONAL STUDY from CDC
in NYC - "There was a significant upward trend in the proportion of HCV infections reported among people with HIV who are MSM. In 2000, 7% of HCV reports among people with HIV were MSM; in 2010, 24% were MSM
IDSA: HIV/Hepatitis C (HCV) Co-infection among Men who have Sex with Men (MSM) in New York City (NYC), 2000-2010 - Increased from 7% to 24% - (10/10/13)
http://www.natap.org/2012/HCV/121812_03.htm.....HCV Screening is Cost Effective vs Not Screening:
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
http://www.natap.org/2013/HCV/101113_01.htm........In 2001 this published study reported that at a major hospital in Boston HCV had become the leading cause of death in HIV+ individuals:
End-stage liver disease is now the leading cause of death in our hospitalized HIV-seropositive population......"In our analysis of causes of death of patients infected with HIV, we found that end-stage liver disease has become the leading cause of death of HIV-seropositive patients at our institution. BUT the causes of death are very often not related to HCV: The various causes of death are summarized in table 2: (50%) of the deaths were the direct result of complications secondary to end-stage liver disease (P = .003). The causes of death of the remaining patients were sepsis, cytomegalovirus disease, AIDS dementia complex, cryptococcal meningitis, progressive multifocal leukoencephalopathy, CNS lymphoma, gastrointestinal bleeding, and end-stage renal disease. In contrast, in group 1, only 11.5% of deaths were associated with end-stage liver disease. .
http://www.natap.org/2013/HCV/040513_02.htm.....This large, retrospective matched comparison cohort study found that patients diagnosed with HCV infection have PPPY all-cause costs that on average are almost twice as much as those of non-HCV patients. Furthermore, PPPY costs were higher in patients with AdvLD. While a majority (82.4%) of patients in the current study had not progressed to AdvLD, epidemiologic data predict that the number of HCV patients with AdvLD and thus health care costs for the HCV population will increase substantially in the next 2 decades......."The burden of AdvLD (advanced liver disease) should be of interest to managed care payers to understand the effects of current and future HCV costs on their plans. Therefore, the purpose of this study was to estimate the all-cause medical costs to payers associated with HCV, both overall and by stage of liver disease. This study focused on enrollees with employer-sponsored health insurance and compared a cohort of HCV patients with a matched comparison cohort of patients without HCV....... For the overall HCV cohort of 34,597 patients, the estimated PPPY cost from 2002 to first quarter of 2010 was $19,660 per patient (in 2009 dollars). This amount was almost twice as high as the PPPY cost for the 330,435 matched comparison enrollees ($9,979)....... The PPPY health care cost identified in the current study for patients with HCV but with no indication of liver disease was $14,915. This amount was $5,870 higher than that of matched comparisons and close to twice the U.S. per capita annual health care expenditure of approximately $8,000 in 2009,5 suggesting that all-cause health care costs for HCV patients are higher than those of non-HCV patients even in the absence of AdvLD
http://www.natap.org/2013/HCV/010713_01.htm.....the prevalence of advanced liver disease will continue to increase, as will the corresponding healthcare costs......we forecast that mortality will continue to increase and peak in 2020......the "incidence of more advanced liver diseases will continue to increase, with incidence of decompensated cirrhosis and HCC peaking in 2016-2017......by 2030, compensated cirrhosis cases will account for 37% of all prevalent cases. The HCV compensated cirrhotic population is projected to peak in 2015, while the decompensated cirrhotic population will peak in 2019"......we forecast that mortality will continue to increase and peak in 2020.....Patients experiencing decompensated cirrhosis accounted for the majority of future costs Lifetime healthcare costs for an HCV infected person are significantly higher than for non-infected persons, and the expected cost is higher among populations with a higher life expectancy. Finally, it is possible to substantially reduce HCV infection in the US through active management.......the prevalence of more advanced liver diseases has been increasing. The prevalent population with compensated cirrhosis is projected to peak in 2015 at 626,500 cases, while the population with decompensated cirrhosis will peak in 2019 with 107,400 cases. The number of individuals with HCC, caused by HCV infection, will increase to 23,800 cases in 2018 before starting to decline. In 2011, the total healthcare cost associated with HCV infection was $6.5 ($4.3-$8.2) billion.......Total cost is expected to peak in 2024 at $9.1 billion ($6.4-$13.3 billion), as shown in Figure 3. The majority of peak cost will be attributable to more advanced liver diseases-decompensated cirrhosis (46%), compensated cirrhosis (20%), and hepatocellular carcinoma (16%). The maximum cost associated with mild to moderate fibrosis (F0-F3) occurred in 2007 at nearly $780 million. The cost associated with compensated cirrhosis is expected to peak in 2022 at $1.9 billion, while the peak cost for decompensated cirrhosis and HCC is predicted to occur in 2025, with annual costs in excess of $4.2 billion and $1.4 billion respectively."
"The effects of new therapies were excluded from our model. However, if the number of treated patients is doubled and kept constant at 126,000 per year in 2012-2030 and the average SVR is increased to 70%, the 2030 prevalent population is projected to be less than 100,000 cases. This illustrates that it is possible to substantially reduce HCV infection in the US through active management."
HCC (liver cancer), hepatocelluar carcinoma rates doubled between 1985 & 1998 nationally. In the 2008 report by the National Institute of Health (NIH) [19], the indirect cost ($1.78 billion in 2004) for hepatitis C was 67% higher than estimated direct costs ($1.1 billion in 2004)."..... http://www.natap.org/2012/HCV/040412_02.htm......."The indirect costs, defined as the cost of forgone earnings or production because of hospitalization, ambulatory care, premature death, and work loss because of acute or chronic infection, were often higher than the direct costs......The mean cost of liver transplantation was estimated at $201 110 (2010 US dollar)......"Our analysis highlights the need for more updated cost studies....HCC cases doubled between 1985 and 1998....Direct cost associated with hepatitis C was estimated at $694-$1660 million per year, HCC (all causes) at $261-$978 million per year, HCC (hepatitis C only) at $140 million per year, and chronic liver diseases and cirrhosis at $1421 million per year"

  iconpaperstack View Older Articles   Back to Top   www.natap.org