VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.
VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
Appl Health Econ Health Policy. 2019 Aug;17(4):513-521. doi: 10.1007/s40258-019-00468-5.
The release of highly effective but costly medications for the treatment of hepatitis C virus combined with a doubling in the incidence of hepatitis C virus have posed substantial financial challenges for many healthcare systems. We provide estimates of the cost of treating patients with hepatitis C virus that can inform the triage of pharmaceutical care in systems with limited healthcare resources.
We conducted an observational study using a national US cohort of 206,090 veterans with laboratory-identified hepatitis C virus followed from Fiscal Year 2010 to 2014. We estimated the cost of: non-advanced Fibrosis-4; advanced Fibrosis-4; hepatocellular carcinoma; liver transplant; and post-liver transplant. The former two stages were ascertained using laboratory result data; the latter stages were ascertained using administrative data. Costs were obtained from the Veterans Health Administration's activity-based cost accounting system and more closely represent the actual costs of providing care, an improvement on the charge data that generally characterizes the hepatitis C virus cost literature. Generalized estimating equations were used to estimate and predict costs per liver disease stage. Missing data were multiply imputed.
Annual costs of care increased as patients progressed from non-advanced Fibrosis-4 to advanced Fibrosis-4, hepatocellular carcinoma, and liver transplant (all p < 0.001). Post-liver transplant, costs decreased significantly (p < 0.001). In simulations, patients were estimated to incur the following annual costs: US $17,556 for non-advanced Fibrosis-4; US $20,791 for advanced Fibrosis-4; US $46,089 for liver cancer; US $261,959 in the year of the liver transplant; and US $18,643 per year after the liver transplant.
Cost differences of treating non-advanced and advanced Fibrosis-4 are relatively small. The greatest cost savings would be realized from avoiding progression to liver cancer and transplant.
高效但昂贵的丙型肝炎病毒治疗药物的推出，加上丙型肝炎病毒发病率的翻番，给许多医疗保健系统带来了巨大的财务挑战。我们提供了治疗丙型肝炎病毒患者的成本估计，这可以为资源有限的医疗保健系统中的药物治疗分诊提供信息。
我们使用美国 206090 名退伍军人的全国队列进行了一项观察性研究，这些退伍军人的实验室检测出丙型肝炎病毒，从 2010 财政年度到 2014 年进行了随访。我们估计了以下各项的成本：非进展性纤维化 4 期；进展性纤维化 4 期；肝细胞癌；肝移植；肝移植后。前两个阶段是通过实验室结果数据确定的；后三个阶段是通过行政数据确定的。成本来自退伍军人健康管理局的基于活动的成本核算系统，更能准确反映提供护理的实际成本，这比通常描述丙型肝炎病毒成本文献的收费数据有所改进。广义估计方程用于估计和预测每个肝病阶段的成本。缺失数据采用多重插补法进行处理。
随着患者从非进展性纤维化 4 期进展到进展性纤维化 4 期、肝细胞癌和肝移植，医疗费用逐年增加（均 P < 0.001）。肝移植后，成本显著下降（P < 0.001）。在模拟中，预计患者每年将产生以下费用：非进展性纤维化 4 期为 17556 美元；进展性纤维化 4 期为 20791 美元；肝癌为 46089 美元；肝移植当年为 261959 美元；肝移植后每年为 18643 美元。
治疗非进展性和进展性纤维化 4 期的成本差异相对较小。避免进展为肝癌和肝移植将带来最大的成本节约。
