Cacoub P, Buggisch P, Carrión J A, Cooke G S, Zignego A L, Beckerman R, Younossi Z
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France.
Sorbonne Université, UPMC Univ Paris 06, INSERM, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France.
J Viral Hepat. 2018 Jul;25(7):811-817. doi: 10.1111/jvh.12881. Epub 2018 Mar 30.
Hepatitis C virus (HCV) infection is a systemic disease associated with both hepatic and extrahepatic manifestations. The burden associated with the hepatic manifestation of HCV infection has been well documented in Europe, although that of HCV extrahepatic manifestations remains unknown. In this study, we estimated the annual direct medical costs associated with HCV extrahepatic manifestations in five European countries. A previously validated economic model was used to estimate the annual direct medical cost associated with HCV extrahepatic manifestations. Global excess prevalence of extrahepatic manifestations in HCV patients relative to that in non-HCV patients was obtained from a recent meta-analysis. Per-patient per-year inpatient, outpatient and medication costs to treat each extrahepatic manifestation were from the literature, national databases or expert opinion if unavailable otherwise. All costs were adjusted to 2016 euros (€). The overall direct medical costs associated with HCV extrahepatic manifestations were calculated by multiplying the total per-patient per-year costs of each by the respective excess prevalence rates and then by the size of the HCV-infected population in each country. Treatment impact with direct-acting antivirals (DAAs) was explored using HCV extrahepatic manifestations excess prevalence rates among cured patients compared to untreated HCV patients, as sourced from a meta-analysis. The total annual direct medical cost associated with HCV extrahepatic manifestations was estimated to be 2.17 billion euro (€), with a per-HCV-patient cost ranging from €899 to €1647 annually. DAA treatment was projected to result in cost savings of €316 million per year. We find that the annual economic burden of extrahepatic manifestations is significant and may be partly mitigated by treatment with DAAs.
丙型肝炎病毒（HCV）感染是一种与肝脏和肝外表现相关的全身性疾病。在欧洲，HCV感染的肝脏表现所带来的负担已有充分记录，但其肝外表现的负担仍不明确。在本研究中，我们估算了五个欧洲国家与HCV肝外表现相关的年度直接医疗费用。我们使用一个先前验证过的经济模型来估算与HCV肝外表现相关的年度直接医疗费用。HCV患者相对于非HCV患者肝外表现的全球额外患病率来自最近的一项荟萃分析。治疗每种肝外表现的每位患者每年的住院、门诊和药物费用来自文献、国家数据库或专家意见（若无法从其他途径获取）。所有费用均按2016年欧元进行调整。与HCV肝外表现相关的总体直接医疗费用通过将每种表现的每位患者每年总费用乘以各自的额外患病率，再乘以每个国家HCV感染人群的规模来计算。使用来自荟萃分析的治愈患者与未治疗的HCV患者相比的HCV肝外表现额外患病率，探讨了直接作用抗病毒药物（DAA）的治疗影响。与HCV肝外表现相关的年度直接医疗总费用估计为21.7亿欧元，每位HCV患者每年的费用在899欧元至1647欧元之间。预计DAA治疗每年可节省3.16亿欧元。我们发现，肝外表现的年度经济负担很大，而DAA治疗可能会部分减轻这一负担。
