Mitra D, Davis KL, Medjedovic J, Beam C, Rustgi VK. Health care utilization and costs associated with chronic hepatitis c in a managed care population. Poster presented at the 2008 ISPOR 13th Annual International Meeting; May 7, 2008. [abstract] Value Health. 2008 May; 11(3):A103.

OBJECTIVE: Hepatitis C virus (HCV) is one of the most common blood-borne infections in the US. Although it carries a potentially high economic burden for managed care systems, HCV-related medical costs have not been widely investigated using administrative data. Our objective was to analyze retrospective insurance claims to document resource utilization and costs associated with chronic HCV among managed care enrollees.

METHODS: A large US claims database was analyzed from 1/1/2002 through 12/31/2006. Inclusion criteria were: 1 diagnosis of chronic HCV (ICD-9 070.44, 070.54, 070.70, or 070.71); no evidence of hepatitis B; 12 months of continuous plan enrollment post-diagnosis. Per patient use and costs of HCV-specific medical services and prescriptions were assessed over 12 months post-diagnosis. HCV-specific encounters were identified as claims on which HCV was a coded diagnosis. Encounters were stratified by setting of care (e.g. office visits, hospitalizations). HCV-specific pharmacy utilization included prescriptions for combination peginterferon or interferon with ribavirin, peginterferon and interferon monotherapies, and consensus interferon.

RESULTS: 20,662 patients met all inclusion criteria. Mean age was 49 years and 61% were male. Total HCV-specific treatment costs were $6864 per patient. Patients had, on average, 14 HCV-specific encounters. Nearly 65% had an HCV-related office visit, with 3 visits on average. Over 48% had an HCV-specific laboratory test, with 5 tests on average and total costs of $281. More than 14% of patients had an HCVrelated hospitalization, with average costs of $2078 per patient and 5 inpatient days. 19% of patients had an HCV-specific prescription with prescription costs ($3433) accounting for nearly half of the total costs. HCV-specific home visits, skilled nursing stays, and ER visits were seen in <5% of patients.

CONCLUSION: Chronic HCV is a costly condition. Pharmacy and inpatient services are primary drivers of HCV-related expenditures. Expanded efforts in HCV treatment may result in cost savings for managed care systems.