Dimitrova Maria, Pavlov Kaloyan, Mitov Konstantin, Genov Jordan, Petrova Guenka Ivanova
Faculty of Pharmacy, Medical University, Sofia, Bulgaria.
University Hospital "Queen Joanna-ISUL", Sofia, Bulgaria.
Front Med (Lausanne). 2017 Aug 7;4:125. doi: 10.3389/fmed.2017.00125. eCollection 2017.
HCV infection is a leading cause of chronic liver disease with long-term complications-extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital "Queen Joanna-ISUL" for 3-year period (2012-2014).
It is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital "Queen Joanna-ISUL" for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy) were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF), hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal-Wallis, and Friedman tests were used for statistical processing.
76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839) with an average cost per patient 4,577 BGN (€2,340). Statistically significant correlation was observed between the total cost per patient from the different payers' perspective and the Child-Pugh cirrhosis score.
HCV-related cirrhosis is resource demanding and sets high direct medical costs as it is related with increased hospitalizations and complications acquiring additional treatment.
丙型肝炎病毒（HCV）感染是导致慢性肝病及长期并发症（广泛纤维化、肝硬化和肝细胞癌）的主要原因。本研究的目的是对在“乔安娜女王 - 伊苏尔大学医院”住院治疗3年（2012 - 2014年）的慢性HCV相关肝硬化患者的治疗进行成本分析。
这是一项前瞻性的、基于现实生活的观察性研究，对297例慢性HCV感染和肝硬化患者在“乔安娜女王 - 伊苏尔大学医院”进行了为期3年的监测。收集了人口统计学、临床特征以及医疗资源利用情况（住院治疗、高度专业化干预和药物治疗）的数据。采用微观成本核算方法评估总直接医疗成本。分析视角包括国家健康保险基金（NHIF）、医院和患者。收集的成本数据来自NHIF和医院收费标准、患者以及药品价格正面清单。使用描述性统计、卡方检验、Kruskal - Wallis检验和Friedman检验进行统计处理。
76%的患者为男性。93%的患者被诊断为Child - Pugh A级和B级。97%的患者报告有并发症，几乎所有患者都出现了食管静脉曲张。在3年的观察期内，患者的Child - Pugh状态关键临床值未发生变化，因此该组被视为同质组。3年期间记录了847次住院治疗，平均住院时间为17天。死亡率为6.90%，极高。观察队列患者3年期间的总直接医疗成本为1,290,533保加利亚列弗（659,839欧元），平均每位患者成本为4,577保加利亚列弗（2,340欧元）。从不同支付方角度来看，每位患者的总成本与Child - Pugh肝硬化评分之间存在统计学上的显著相关性。
HCV相关肝硬化需要大量资源，且由于住院次数增加和并发症需额外治疗，导致直接医疗成本高昂。
