Direct Economic Burden of Chronic Hepatitis C Virus in a United States Managed Care Population

Goals and Background: To estimate all-cause and disease-related resource utilization and costs among managed care enrollees with chronic hepatitis C virus (HCV). Study: A large United States claims database was analyzed (1/1/ 2002 to 12/31/2006). Inclusion criteria were: diagnosis of chronic HCV; no hepatitis B diagnoses; >= 6 and >= 12 months of continuous plan enrollment prediagnosis and postdiagnosis, respectively. Use and costs of medical services and prescription drugs over a 12-month period postdiagnosis were evaluated. Outcomes were assessed in controls without HCV matched (1: 1) on age, sex, and plan enrollment. All cost estimates were generated using multivariate generalized linear models to adjust for additional covariates and skewness common in health care cost data. Results: Of the 20,662 patients who met all inclusion criteria, mean age was 49 years; 61% were male. Adjusted all-cause costs were $20,961 per HCV patient, compared with $5451 per control (P < 0.0001). Hospitalization occurred in 24% of HCV patients compared with 7% of controls (P < 0.0001). Mean inpatient costs were $5892 and $1159 per patient, respectively (P < 0.0001). Patients with HCV had higher prescription costs compared with controls ($6191 vs. $1315; P < 0.0001). At $6864 per patient, disease-related costs were nearly one-third of all costs in patients with HCV, which exceeded all-cause costs among controls by 26% (P < 0.0001). Conclusions: Chronic HCV is a costly disease to managed care organizations. Disease-related costs in HCV exceed all-cause costs in demographically matched controls. Increased efforts in HCV screening and early treatment, particularly before progression to liver cirrhosis, may lead to long-term cost savings in HCV management for managed care systems.