Goolsby Hunter Alyssa, Rosenblatt Lisa, Patel Chad, Blauer-Peterson Cori, Anduze-Faris Beatrice
a HEOR, Optum , Eden Prairie , USA.
b Bristol-Myers Squibb , Plainsboro , USA.
Curr Med Res Opin. 2017 May;33(5):829-836. doi: 10.1080/03007995.2017.1288613. Epub 2017 Feb 10.
In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored.
In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics.
Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity.
The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs.
Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients.
These results suggest that liver disease progression varies by genotype and that CHC patients with GT3 appear to have more severe liver disease. These findings highlight the importance of effective HCV treatment for all patients and support guidelines for treatment of high-risk patients, including those with GT3.
在美国，约有300万人感染丙型肝炎病毒（HCV）。HCV的基因型对疾病进展和治疗反应有不同影响。然而，HCV基因型与肝病进展、医疗资源利用及医疗费用之间的关系尚未得到充分研究。
在这项针对慢性丙型肝炎（CHC）患者的回顾性研究中，利用美国一个大型健康计划的医疗理赔数据收集患者人口统计学和临床特征数据。
主要观察指标包括医疗资源利用（HCRU）和医疗费用。相关实验室数据提供了基因型及用于确定肝病严重程度的选定指标。
该样本（平均年龄50.6岁，63.5%为男性）包括10331名患者，其中79.1%为基因（GT）1型，12.8%为GT2型，8.1%为GT3型。描述性分析表明，HCV基因型在肝脏及非肝脏相关合并症、肝病严重程度和医疗费用方面存在差异。GT3型患者中与肝脏相关合并症和晚期肝病患者的比例最高。同时，GT2型患者的HCRU较低且费用最低，GT1型患者的全因总费用最高。这些差异可能反映了非肝脏相关合并症和全因护理的不同发生率。多变量分析显示，基因型是费用和肝病严重程度的重要预测因素：与GT1型患者相比，GT3型患者患晚期肝病的可能性显著更高。GT2型患者患晚期疾病的可能性显著更低，且全因费用更低的可能性更大。
结果可能不适用于所代表的商业保险计划之外的患者，且对现患人群的分析相对于治疗患者样本可能低估了HCRU和费用。
这些结果表明，肝病进展因基因型而异，GT3型CHC患者似乎患有更严重的肝病。这些发现凸显了对所有患者进行有效HCV治疗的重要性，并支持对高危患者（包括GT3型患者）的治疗指南。
