Stanford University Medical Center, United States.
Gilead Sciences, Inc., United States.
J Hepatol. 2019 Jan;70(1):24-32. doi: 10.1016/j.jhep.2018.09.021. Epub 2018 Oct 1.
BACKGROUND & AIMS: Chronic hepatitis B (CHB) affects over 2 million people in the US, with little reported on healthcare utilization and cost. We aimed to quantify annual CHB utilization and costs by disease severity and payer type.
Using Commercial, Medicare, and Medicaid databases from 2004 to 2015 and ICD9 codes, we retrospectively identified adults with CHB, analyzing all-cause inpatient, outpatient, and pharmaceutical utilization and costs by disease severity. We compared healthcare utilization and costs between patients with CHB, without advanced liver disease, and matched non-CHB controls. All-cause inpatient, outpatient, and pharmaceutical utilization and costs were reported for each year and adjusted to 2015 dollars.
Our sample consisted of 33,904 CHB cases and 86,072 non-CHB controls. All-cause inpatient admissions (average stay 6-10 days) were more frequent in advanced liver disease states. Across all payers, patients with decompensated cirrhosis had the highest emergency department utilization (1.6-2.8 annual visits) and highest mean annual costs. The largest all-cause cost components for Commercial and Medicaid were inpatient costs for all advanced liver disease groups (Commercial: 62%, 47%, 68%; Medicaid: 81%, 72%, 74%, respectively), and decompensated cirrhosis and hepatocellular carcinoma groups for Medicare (Medicare 49% and 48%). In addition, patients with compensated liver disease incurred costs 3 times higher than non-CHB controls.
Patients with CHB, regardless of payer, who experienced decompensated cirrhosis, hepatocellular carcinoma, or a liver transplant incurred the highest annual costs and utilization of healthcare resources, but even patients with CHB and compensated liver disease incurred higher costs than those without CHB. All stakeholders in disease management need to combine efforts to prevent infection and advanced liver disease through improved vaccination rates, earlier diagnosis, and treatment.
Hepatitis B virus can be a progressive disease leading to cirrhosis, hepatocellular carcinoma, liver transplant, and death. These progressive disease states are associated with a higher rate of hospitalizations, emergency room visits, outpatient visits, and costs compared to similar patients without hepatitis B. The most ill patients have the highest costs, but even patients who are less sick experience higher costs than patients without hepatitis B.
慢性乙型肝炎（CHB）影响了美国超过 200 万人，但其医疗保健的利用和成本却鲜有报道。我们旨在根据疾病严重程度和支付者类型来量化 CHB 的年度利用和成本。
我们使用了 2004 年至 2015 年的商业、医疗保险和医疗补助数据库以及 ICD9 代码，回顾性地确定了患有 CHB 的成年人，分析了所有病因的住院、门诊和药物利用情况以及按疾病严重程度划分的成本。我们比较了 CHB 患者与无晚期肝病和匹配的非 CHB 对照患者的医疗保健利用和成本。报告了每年的所有病因住院、门诊和药物利用情况，并将其调整为 2015 年的美元。
我们的样本包括 33904 例 CHB 病例和 86072 例非 CHB 对照。在所有支付者中，失代偿性肝硬化患者的急诊就诊次数最多（每年 1.6-2.8 次），年平均费用最高。商业保险和医疗补助中所有失代偿性肝硬化和肝细胞癌患者的最大全因费用部分是住院费用（商业保险：62%、47%、68%；医疗补助：81%、72%、74%），而 Medicare 则是失代偿性肝硬化和肝细胞癌患者（医疗保险 49%和 48%）。此外，代偿性肝病患者的费用比非 CHB 对照者高 3 倍。
无论支付者如何，患有 CHB 的患者经历了失代偿性肝硬化、肝细胞癌或肝移植，其年度医疗保健资源的利用和成本最高，但即使是患有 CHB 且代偿性肝病的患者的费用也高于非 CHB 患者。疾病管理的所有利益相关者都需要共同努力，通过提高疫苗接种率、早期诊断和治疗，来预防感染和晚期肝病。
乙型肝炎病毒可导致肝硬化、肝癌、肝移植和死亡等进行性疾病。与没有乙型肝炎的相似患者相比，这些进行性疾病状态与更高的住院率、急诊就诊率、门诊就诊率和费用相关。病情最严重的患者费用最高，但即使是病情较轻的患者，其费用也高于没有乙型肝炎的患者。
