The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration.
Identifieur interne : 000468 ( Main/Corpus ); précédent : 000467; suivant : 000469The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration.
Auteurs : Risha Gidwani-Marszowski ; Douglas K. Owens ; Jeanie Lo ; Jeremy D. Goldhaber-Fiebert ; Steven M. Asch ; Paul G. BarnettSource :
- Applied health economics and health policy [ 1179-1896 ] ; 2019.
English descriptors
- KwdEn :
- Aged (MeSH), Antiviral Agents (economics), Cost-Benefit Analysis (MeSH), Female (MeSH), Hepacivirus (MeSH), Hepatitis C, Chronic (drug therapy), Hepatitis C, Chronic (economics), Humans (MeSH), Liver Cirrhosis (pathology), Male (MeSH), Middle Aged (MeSH), United States (MeSH), Veterans Health (MeSH).
- MESH :
- chemical , economics : Antiviral Agents.
- geographic : United States.
- drug therapy : Hepatitis C, Chronic.
- economics : Hepatitis C, Chronic.
- pathology : Liver Cirrhosis.
- Aged, Cost-Benefit Analysis, Female, Hepacivirus, Humans, Male, Middle Aged, Veterans Health.
Abstract
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
DOI: 10.1007/s40258-019-00468-5
PubMed: 31030359
Links to Exploration step
pubmed:31030359Le document en format XML
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(152 MPD), Menlo Park, CA, 94025, USA. risha.gidwani@va.gov.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA. risha.gidwani@va.gov.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. risha.gidwani@va.gov.</nlm:affiliation></affiliation></author><author><name sortKey="Owens, Douglas K" sort="Owens, Douglas K" uniqKey="Owens D" first="Douglas K" last="Owens">Douglas K. Owens</name><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Lo, Jeanie" sort="Lo, Jeanie" uniqKey="Lo J" first="Jeanie" last="Lo">Jeanie Lo</name><affiliation><nlm:affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Goldhaber Fiebert, Jeremy D" sort="Goldhaber Fiebert, Jeremy D" uniqKey="Goldhaber Fiebert J" first="Jeremy D" last="Goldhaber-Fiebert">Jeremy D. Goldhaber-Fiebert</name><affiliation><nlm:affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Asch, Steven M" sort="Asch, Steven M" uniqKey="Asch S" first="Steven M" last="Asch">Steven M. Asch</name><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><affiliation><nlm:affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2019">2019</date><idno type="RBID">pubmed:31030359</idno><idno type="pmid">31030359</idno><idno type="doi">10.1007/s40258-019-00468-5</idno><idno type="wicri:Area/Main/Corpus">000468</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000468</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration.</title><author><name sortKey="Gidwani Marszowski, Risha" sort="Gidwani Marszowski, Risha" uniqKey="Gidwani Marszowski R" first="Risha" last="Gidwani-Marszowski">Risha Gidwani-Marszowski</name><affiliation><nlm:affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA. risha.gidwani@va.gov.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA. risha.gidwani@va.gov.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. risha.gidwani@va.gov.</nlm:affiliation></affiliation></author><author><name sortKey="Owens, Douglas K" sort="Owens, Douglas K" uniqKey="Owens D" first="Douglas K" last="Owens">Douglas K. Owens</name><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Lo, Jeanie" sort="Lo, Jeanie" uniqKey="Lo J" first="Jeanie" last="Lo">Jeanie Lo</name><affiliation><nlm:affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Goldhaber Fiebert, Jeremy D" sort="Goldhaber Fiebert, Jeremy D" uniqKey="Goldhaber Fiebert J" first="Jeremy D" last="Goldhaber-Fiebert">Jeremy D. Goldhaber-Fiebert</name><affiliation><nlm:affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Asch, Steven M" sort="Asch, Steven M" uniqKey="Asch S" first="Steven M" last="Asch">Steven M. Asch</name><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><affiliation><nlm:affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Applied health economics and health policy</title><idno type="eISSN">1179-1896</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Antiviral Agents (economics)</term><term>Cost-Benefit Analysis (MeSH)</term><term>Female (MeSH)</term><term>Hepacivirus (MeSH)</term><term>Hepatitis C, Chronic (drug therapy)</term><term>Hepatitis C, Chronic (economics)</term><term>Humans (MeSH)</term><term>Liver Cirrhosis (pathology)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>United States (MeSH)</term><term>Veterans Health (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Antiviral Agents</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Hepatitis C, Chronic</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Hepatitis C, Chronic</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Liver Cirrhosis</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Cost-Benefit Analysis</term><term>Female</term><term>Hepacivirus</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Veterans Health</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31030359</PMID><DateCompleted><Year>2020</Year><Month>07</Month><Day>03</Day></DateCompleted><DateRevised><Year>2020</Year><Month>07</Month><Day>03</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1179-1896</ISSN><JournalIssue CitedMedium="Internet"><Volume>17</Volume><Issue>4</Issue><PubDate><Year>2019</Year><Month>08</Month></PubDate></JournalIssue><Title>Applied health economics and health policy</Title><ISOAbbreviation>Appl Health Econ Health Policy</ISOAbbreviation></Journal><ArticleTitle>The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration.</ArticleTitle><Pagination><MedlinePgn>513-521</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s40258-019-00468-5</ELocationID><Abstract><AbstractText Label="BACKGROUND">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.</AbstractText><AbstractText Label="METHODS">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.</AbstractText><AbstractText Label="RESULTS">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.</AbstractText><AbstractText Label="CONCLUSIONS">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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gidwani-Marszowski</LastName><ForeName>Risha</ForeName><Initials>R</Initials><Identifier Source="ORCID">http://orcid.org/0000-0002-3548-2332</Identifier><AffiliationInfo><Affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA. risha.gidwani@va.gov.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA. risha.gidwani@va.gov.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. risha.gidwani@va.gov.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Owens</LastName><ForeName>Douglas K</ForeName><Initials>DK</Initials><AffiliationInfo><Affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lo</LastName><ForeName>Jeanie</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Goldhaber-Fiebert</LastName><ForeName>Jeremy D</ForeName><Initials>JD</Initials><AffiliationInfo><Affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Asch</LastName><ForeName>Steven M</ForeName><Initials>SM</Initials><AffiliationInfo><Affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barnett</LastName><ForeName>Paul G</ForeName><Initials>PG</Initials><AffiliationInfo><Affiliation>VA Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA, 94025, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University, Stanford, CA, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>I01 HX000889-1A1</GrantID><Agency>United States Department of Veterans Affairs</Agency><Country>International</Country></Grant><Grant><GrantID>K01 AG037593</GrantID><Acronym>AG</Acronym><Agency>NIA NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType><PublicationType UI="D013486">Research Support, U.S. Gov't, Non-P.H.S.</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>New Zealand</Country><MedlineTA>Appl Health Econ Health Policy</MedlineTA><NlmUniqueID>101150314</NlmUniqueID><ISSNLinking>1175-5652</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="N">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003362" MajorTopicYN="N">Cost-Benefit Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016174" MajorTopicYN="N">Hepacivirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019698" MajorTopicYN="N">Hepatitis C, Chronic</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008103" MajorTopicYN="N">Liver Cirrhosis</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058014" MajorTopicYN="Y">Veterans Health</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>4</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>7</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>4</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31030359</ArticleId><ArticleId IdType="doi">10.1007/s40258-019-00468-5</ArticleId><ArticleId IdType="pii">10.1007/s40258-019-00468-5</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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