Health Sciences Practice, Kantar Health, New York, NY, USA.
J Med Econ. 2011;14(2):253-61. doi: 10.3111/13696998.2011.566294. Epub 2011 Mar 9.
Between 2.7 and 3.9 million people are currently infected with the hepatitis C virus (HCV) in the United States. Although many studies have investigated the impact of HCV on direct healthcare costs, few studies have estimated the indirect costs associated with the virus using a nationally-representative dataset.
Using data from the 2009 United States (US) National Health and Wellness Survey, patients who reported a hepatitis C diagnosis (n = 695) were compared to controls on labor force participation, productivity loss, and activity impairment after adjusting for demographics, health risk behaviors, and comorbidities. All analyses applied sampling weights to project to the population.
Patients with HCV were significantly less likely to be in the labor force than controls and reported significantly higher levels of absenteeism (4.88 vs. 3.03%), presenteeism (16.69 vs. 13.50%), overall work impairment (19.40 vs.15.35%), and activity impairment (25.01 vs. 21.78%). A propensity score matching methodology replicated many of these findings.
While much of the work on HCV has focused on direct costs, our results suggest indirect costs should not be ignored when quantifying the societal burden of HCV. To our knowledge, this is the first study which has utilized a large, nationally-representative data source for identifying the impact of HCV on labor force participation and work and activity impairment using both a propensity-score matching and a regression modeling framework.
All data were patient-reported (including HCV diagnosis and work productivity), which could have introduced some subjective biases.
目前美国有 270 万至 390 万人感染丙型肝炎病毒(HCV)。虽然许多研究已经调查了 HCV 对直接医疗保健成本的影响,但很少有研究使用全国代表性数据集来估计与该病毒相关的间接成本。
使用 2009 年美国(US)国家健康与健康调查的数据,将报告丙型肝炎诊断的患者(n=695)与对照组进行比较,在调整人口统计学、健康风险行为和合并症后,比较他们的劳动力参与率、生产力损失和活动障碍。所有分析均应用抽样权重来预测人群。
与对照组相比,丙型肝炎患者的劳动力参与率显著较低,旷工率(4.88%比 3.03%)、在职病假率(16.69%比 13.50%)、总体工作障碍率(19.40%比 15.35%)和活动障碍率(25.01%比 21.78%)显著较高。倾向评分匹配方法复制了许多这些发现。
虽然对 HCV 的大部分研究都集中在直接成本上,但我们的结果表明,在量化 HCV 的社会负担时,不应忽视间接成本。据我们所知,这是第一项利用大型全国代表性数据源,使用倾向评分匹配和回归建模框架来确定 HCV 对劳动力参与和工作及活动障碍影响的研究。
所有数据均为患者报告(包括 HCV 诊断和工作生产力),这可能引入了一些主观偏见。