The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective
<p>Abstract</p> <p>Background</p> <p>Chronic hepatitis C virus (HCV) may progress to advanced liver disease (ALD), including decompensated cirrhosis and/or hepatocellular carcinoma (HCC). ALD can lead to significant clinical and economic consequences, including liver tr...
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| Format: | Article |
| Language: | English |
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BMC
2012-12-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://www.biomedcentral.com/1472-6963/12/459 |
| _version_ | 1818063319145119744 |
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| author | Menzin Joseph White Leigh Ann Nichols Christine Deniz Baris |
| author_facet | Menzin Joseph White Leigh Ann Nichols Christine Deniz Baris |
| author_sort | Menzin Joseph |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Chronic hepatitis C virus (HCV) may progress to advanced liver disease (ALD), including decompensated cirrhosis and/or hepatocellular carcinoma (HCC). ALD can lead to significant clinical and economic consequences, including liver transplantation. This study evaluated the health care costs associated with ALD among HCV infected patients in a Medicaid population.</p> <p>Methods</p> <p>Using Florida Medicaid claims data, cases were patients with at least 1 diagnosis of HCV or prescription therapy for HCV (ribavirin plus interferon, peginterferon, or interferon alfacon-1) prior to an incident ALD-related diagnosis (“index event”) between 1999 and 2007. ALD-related conditions included decompensated cirrhosis, HCC, or liver transplant. A cohort of HCV patients without ALD (comparison group subjects) were matched 1-to-1 based on age, sex, and race. Baseline and follow-up were the 12 months prior to and following index, respectively; with both periods allowing for a maximum one month gap in eligibility. For both case and comparison patient cohorts, per-patient-per-eligible month (PPPM) costs were calculated as total Medicaid paid amount for each patient over their observed number of eligible months in follow-up, divided by the patient’s total number of eligible months. A generalized linear model (GLM) was constructed controlling for age, race, Charlson score, alcoholic cirrhosis, and hepatitis B to explore all-cause PPPM costs between study groups. The final study group included 1,193 cases and matched comparison patients (mean age: 49 years; 45% female; 54% white, 23% black, 23% other).</p> <p>Results</p> <p>The majority of ALD-related diagnoses were for decompensated cirrhosis (92%), followed by HCC (6%) and liver transplant (2%). Cases had greater comorbidity (mean Charlson score: 3.1 vs. 2.3, <it>P</it> < 0.001). All-cause inpatient use up to 1-year following incident ALD diagnosis was significantly greater among cases with ALD (74% vs. 27%, <it>P</it> < 0.001). In the GLM, cases had 2.39 times greater total adjusted mean all-cause PPPM costs compared to the comparison group ($4,956 vs. $1,735 respectively; P < 0.001). Among cases, mean total unadjusted ALD-related costs were $1,356 PPPM, which were largely driven by inpatient costs ($1,272).</p> <p>Conclusions</p> <p>Our results suggest that among patients diagnosed with HCV, the incremental costs of developing ALD are substantial, with inpatient stays as the main driver of these increased costs.</p> |
| first_indexed | 2024-12-10T14:18:13Z |
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| last_indexed | 2024-12-10T14:18:13Z |
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| spelling | doaj.art-be9fd60fc86c45279cfa4c77a036f0aa2022-12-22T01:45:16ZengBMCBMC Health Services Research1472-69632012-12-0112145910.1186/1472-6963-12-459The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspectiveMenzin JosephWhite Leigh AnnNichols ChristineDeniz Baris<p>Abstract</p> <p>Background</p> <p>Chronic hepatitis C virus (HCV) may progress to advanced liver disease (ALD), including decompensated cirrhosis and/or hepatocellular carcinoma (HCC). ALD can lead to significant clinical and economic consequences, including liver transplantation. This study evaluated the health care costs associated with ALD among HCV infected patients in a Medicaid population.</p> <p>Methods</p> <p>Using Florida Medicaid claims data, cases were patients with at least 1 diagnosis of HCV or prescription therapy for HCV (ribavirin plus interferon, peginterferon, or interferon alfacon-1) prior to an incident ALD-related diagnosis (“index event”) between 1999 and 2007. ALD-related conditions included decompensated cirrhosis, HCC, or liver transplant. A cohort of HCV patients without ALD (comparison group subjects) were matched 1-to-1 based on age, sex, and race. Baseline and follow-up were the 12 months prior to and following index, respectively; with both periods allowing for a maximum one month gap in eligibility. For both case and comparison patient cohorts, per-patient-per-eligible month (PPPM) costs were calculated as total Medicaid paid amount for each patient over their observed number of eligible months in follow-up, divided by the patient’s total number of eligible months. A generalized linear model (GLM) was constructed controlling for age, race, Charlson score, alcoholic cirrhosis, and hepatitis B to explore all-cause PPPM costs between study groups. The final study group included 1,193 cases and matched comparison patients (mean age: 49 years; 45% female; 54% white, 23% black, 23% other).</p> <p>Results</p> <p>The majority of ALD-related diagnoses were for decompensated cirrhosis (92%), followed by HCC (6%) and liver transplant (2%). Cases had greater comorbidity (mean Charlson score: 3.1 vs. 2.3, <it>P</it> < 0.001). All-cause inpatient use up to 1-year following incident ALD diagnosis was significantly greater among cases with ALD (74% vs. 27%, <it>P</it> < 0.001). In the GLM, cases had 2.39 times greater total adjusted mean all-cause PPPM costs compared to the comparison group ($4,956 vs. $1,735 respectively; P < 0.001). Among cases, mean total unadjusted ALD-related costs were $1,356 PPPM, which were largely driven by inpatient costs ($1,272).</p> <p>Conclusions</p> <p>Our results suggest that among patients diagnosed with HCV, the incremental costs of developing ALD are substantial, with inpatient stays as the main driver of these increased costs.</p>http://www.biomedcentral.com/1472-6963/12/459Hepatocellular carcinomaDecompensated cirrhosisCostAdministrative claims databasesPayersHCVHepatitis C |
| spellingShingle | Menzin Joseph White Leigh Ann Nichols Christine Deniz Baris The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective BMC Health Services Research Hepatocellular carcinoma Decompensated cirrhosis Cost Administrative claims databases Payers HCV Hepatitis C |
| title | The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective |
| title_full | The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective |
| title_fullStr | The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective |
| title_full_unstemmed | The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective |
| title_short | The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective |
| title_sort | economic burden of advanced liver disease among patients with hepatitis c virus a large state medicaid perspective |
| topic | Hepatocellular carcinoma Decompensated cirrhosis Cost Administrative claims databases Payers HCV Hepatitis C |
| url | http://www.biomedcentral.com/1472-6963/12/459 |
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