Kieran Jennifer Ann, Norris Suzanne, O'Leary Aisling, Walsh Cathal, Merriman Raphael, Houlihan D, McCormick P Aiden, McKiernan Susan, Bergin Colm, Barry Michael
Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
National Centre for Pharmacoeconomics, St. James Hospital, Dublin, Ireland.
BMC Infect Dis. 2015 Oct 26;15:471. doi: 10.1186/s12879-015-1208-1.
Recent advances in Hepatitis C therapeutics offer the possibility of cure but will be expensive. The cost of treatment may be partially offset by the avoidance of advanced liver disease. We performed a micro-costing study of the ambulatory healthcare utilisation of patients with Hepatitis C supplemented with inpatient diagnosis related group costs.
The staff utilisation costs associated with a Hepatitis C ambulatory visit were measured and combined with the costs of investigations to establish a mean cost per consultation. An annualised estimate of cost was produced by multiplying this by the number of consultations accessed, stratified by degree of liver impairment. Inpatient costs were established by identifying the number of inpatient episodes and multiplying by Irish diagnosis related group costs. Non-parametric bootstrapping was performed to derive mean and 95%CI values.
Two hundred and twenty-five patients were identified. The cost of an outpatient medical review was €136 (€3.60 SD). The cost of a Hepatitis C nursing review was €128 (€7.30 SD). The annual mean costs of care were as follows (95%CI): Mild €398 (€336, €482), Moderate €417(€335, €503), Compensated cirrhosis €1790 (€990, €3164), Decompensated cirrhosis €8302 (€3945, €14,637), Transplantation Year 1 €137,176 (€136,024, €138,306), Transplantation after Year 1 €5337 (€4942, €5799), Hepatocellular carcinoma €21,992 (€15,222, €29,467), Sustained virological response €44 (€16, €73).
The direct medical cost associated with Hepatitis C care in Ireland is substantial and increases exponentially with progression of liver disease. The follow-up costs of patients with a sustained virological response in this cohort were low in comparison to patients with chronic infection.
丙型肝炎治疗方法的最新进展提供了治愈的可能性，但成本高昂。治疗费用可能会因避免晚期肝病而得到部分抵消。我们进行了一项微观成本研究，对丙型肝炎患者的门诊医疗利用情况进行了补充，并纳入了住院诊断相关组的成本。
测量了与丙型肝炎门诊就诊相关的工作人员利用成本，并与检查成本相结合，以确定每次会诊的平均成本。通过将此成本乘以按肝损伤程度分层的会诊次数，得出年度成本估计值。通过确定住院次数并乘以爱尔兰诊断相关组成本来确定住院成本。进行非参数自抽样以得出均值和95%置信区间值。
共识别出225名患者。门诊医疗检查的成本为136欧元（标准差3.60欧元）。丙型肝炎护理检查的成本为128欧元（标准差7.30欧元）。年度平均护理成本如下（95%置信区间）：轻度398欧元（336欧元，482欧元），中度417欧元（335欧元，503欧元），代偿期肝硬化1790欧元（990欧元，3164欧元），失代偿期肝硬化8302欧元（3945欧元，14637欧元），移植第1年137176欧元（136024欧元，138306欧元），移植1年后5337欧元（4942欧元，5799欧元），肝细胞癌21992欧元（15222欧元，29467欧元），持续病毒学应答44欧元（16欧元，73欧元）。
爱尔兰与丙型肝炎护理相关的直接医疗成本很高，并且随着肝病进展呈指数增长。与慢性感染患者相比，该队列中具有持续病毒学应答的患者的随访成本较低。
