Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
University of Florida College of Pharmacy, Gainesville, Florida.
Gastroenterology. 2016 Jun;150(7):1599-1608. doi: 10.1053/j.gastro.2016.02.039. Epub 2016 Feb 26.
BACKGROUND & AIMS: Hepatitis C virus (HCV) infection has hepatic and extrahepatic manifestations with various costs and impairments to health-related quality of life (HRQL). We performed a meta-analysis to determine the prevalence of extrahepatic manifestations in patients with HCV infection, how these impair HRQL, and their costs.
We performed systematic reviews of the literature using MEDLINE, CINAHL, and the Cochrane Systematic Review Database, from 1996 through December 2014, to identify studies of the following extrahepatic manifestations of HCV infection: mixed cryoglobulinemia, chronic kidney or end-stage renal disease, type 2 diabetes, B-cell lymphoma, lichen planus, Sjögren's syndrome, porphyria cutanea tarda, rheumatoid-like arthritis, or depression. We performed a separate meta-analysis for each condition to determine prevalence rates of extrahepatic manifestations of HCV infection and their effects on HRQL. We determined the annual costs (inpatient, outpatient, and pharmacy) associated with extrahepatic manifestations of HCV infection.
In an analysis of data from 102 studies, we found the most common extrahepatic manifestations to be diabetes (in 15% of patients) and depression (in 25% of patients). HRQL data showed that HCV infection had negative effects on overall physical and mental health. Total direct medical costs of extrahepatic manifestations of HCV infection, in 2014 US dollars, were estimated to be $1506 million (range, $922 million-$2208 million in sensitivity analysis).
In a systematic review and meta-analysis we determined the prevalence, risks, and costs associated with extrahepatic manifestations of HCV infection. These estimates should be added to the liver-related burden of disease to obtain a more accurate assessment of the total burden of chronic HCV infection. Prospective, real-world studies are needed to increase our understanding of the total clinical and economic effects of HCV infection and treatment on patients and society.
丙型肝炎病毒（HCV）感染具有肝脏和肝脏外表现，对健康相关生活质量（HRQL）造成各种损失和损害。我们进行了一项荟萃分析，以确定 HCV 感染患者的肝脏外表现的患病率，这些表现如何损害 HRQL，以及它们的成本。
我们使用 MEDLINE、CINAHL 和 Cochrane 系统评价数据库进行了系统文献综述，从 1996 年到 2014 年 12 月，以确定 HCV 感染的以下肝脏外表现的研究：混合性冷球蛋白血症、慢性肾脏病或终末期肾病、2 型糖尿病、B 细胞淋巴瘤、扁平苔藓、干燥综合征、迟发性皮肤卟啉症、类风湿样关节炎或抑郁症。我们对每种情况进行了单独的荟萃分析，以确定 HCV 感染的肝脏外表现的患病率及其对 HRQL 的影响。我们确定了与 HCV 感染的肝脏外表现相关的年度成本（住院、门诊和药房）。
在对 102 项研究的数据进行分析后，我们发现最常见的肝脏外表现是糖尿病（15%的患者）和抑郁症（25%的患者）。HRQL 数据显示，HCV 感染对整体身心健康有负面影响。2014 年，HCV 感染肝脏外表现的总直接医疗成本估计为 1.506 亿美元（敏感性分析中为 9220 万至 2.208 亿美元）。
在一项系统评价和荟萃分析中，我们确定了 HCV 感染的肝脏外表现的患病率、风险和成本。这些估计应加入到与肝脏相关的疾病负担中，以更准确地评估慢性 HCV 感染的总负担。需要前瞻性的真实世界研究来提高我们对 HCV 感染及其治疗对患者和社会的总体临床和经济影响的理解。
