All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective
All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective
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DOI：
10.18553/jmcp.2011.17.7.531
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发表时间：
2011-09-01
影响因子：
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通讯作者：
Brixner, Diana I.
中科院分区：
文献类型：
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作者：
McAdam-Marx, Carrie;McGarry, Lisa J.;Brixner, Diana I.
背景：大约320 - 390万美国居民感染丙型肝炎病毒（HCV）。1997年，美国HCV的年度总成本（直接和间接）估计为54.6亿美元，2010年至2019年的10年期间，直接医疗成本预计将增加到107亿美元，部分原因是HCV患者发展为晚期肝病（AdvLD）的人数不断增加。目的：在商业保险参保者的样本中量化(a)诊断为HCV的患者，按总体和肝脏疾病分期计算，每位患者每年（PPPY）支付人的全因费用总额；(b)诊断为HCV的患者相对于匹配的非HCV队列的增量全因成本。方法：这项回顾性、匹配队列研究纳入了从2001年7月1日至2010年3月31日在大型管理医疗组织（MCO）索赔数据库中连续登记至少6个月的年龄至少18岁的患者。将诊断为HCV的患者（ICD-9-CM代码070.54、070.70）分为伴有和不伴有AdvLD的患者，并将AdvLD定义为失代偿性肝硬化（ICD-9-CM代码070.44、070.71、348.3x、456.0、456.1、456.2x、572.2、572.3、572.4、782.4、789.59）；肝细胞癌（HCC， ICD-9-CM代码155）；或肝移植（ICD-9-CM代码V42.7, 50.5或CPT代码47135,47136）。对于无AdvLD的患者，索引日期为首次入组日期后至少6个月观察到的首次HCV诊断日期，并且需要在索引日期后至少连续入组6个月。没有AdvLD的HCV患者被分为有代偿性肝硬化和没有代偿性肝硬化两组（ICD-9-CM代码571.2,571.5,571.6）。对于AdvLD患者，索引日期为首次入组日期后至少6个月观察到的首次AdvLD诊断日期，并且需要在索引日期后至少入组1天。根据性别、年龄、医院转诊地区状态、指数前卫生保健费用、酗酒、人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）和修改的Charlson合并症指数，将病例与符合所有其他纳入标准的无HCV诊断或AdvLD诊断的比较患者按大约1:10的比例进行匹配。对于丙型肝炎和比较患者队列，支付人的PPPY全因成本计算为所有患者的允许总费用除以该队列的随访总患者天数，乘以365，通货膨胀正常化到2009年的美元。由于PPPY成本的计算为每个队列生成一个单一的值，因此使用自举法生成描述性统计。HCV患者相对于非HCV患者的PPPY增量成本计算为PPPY成本的组间差异。使用独立样本的t检验来比较病例和比较队列之间的成本。结果：共有34,597名确诊为HCV的患者，其中78.0%为无AdvLD的HCV， 4.4%为代偿性肝硬化，12.3%为失代偿性肝硬化，2.8%为HCC， 2.6%为肝移植，与330,435名对照患者相匹配。所有HCV病例的平均（SD）年龄为49.9（8.5）岁；61.7%为男性。2009年，所有HCV患者相对于对照组患者的增量平均PPPY成本为9681美元（176美元）。对于无肝病和代偿性肝硬化的HCV患者，PPPY的增量成本分别为5870美元（157美元）和5330美元（491美元）。adld患者的PPPY增量成本为失代偿肝硬化27,845美元（965美元），HCC 43,671美元（2,588美元），移植93,609美元（4,482美元）。包括抗病毒药物在内，HCV患者的增量处方药成本为2739美元（37美元），不累及肝脏的HCV患者为2659美元（41美元），代偿性肝硬化的HCV患者为3102美元（157美元）。组间差异有统计学意义，P
BACKGROUND: Approximately 3.2-3.9 million U.S. residents are infected with the hepatitis C virus (HCV). Total annual costs (direct and indirect) in the United States for HCV were estimated to be $5.46 billion in 1997, and direct medical costs have been predicted to increase to $10.7 billion for the 10-year period from 2010 through 2019, due in part to the increasing number of HCV patients developing advanced liver disease (AdvLD).OBJECTIVE: To quantify in a sample of commercially insured enrollees (a) total per patient per year (PPPY) all-cause costs to the payer, overall and by the stage of liver disease, for patients diagnosed with HCV; and (b) incremental all-cause costs for patients diagnosed with HCV relative to a matched non-HCV cohort.METHODS: This retrospective, matched cohort study included patients aged at least 18 years and with at least 6 months of continuous enrollment in a large managed care organization (MCO) claims database from July 1, 2001, through March 31, 2010. Patients with a diagnosis of HCV (ICD-9-CM codes 070.54, 070.70) were identified and stratified into those with and without AdvLD, defined as decompensated cirrhosis (ICD-9-CM codes 070.44, 070.71, 348.3x, 456.0, 456.1, 456.2x, 572.2, 572.3, 572.4, 782.4, 789.59); hepatocellular carcinoma (HCC, ICD-9-CM code 155); or liver transplant (ICD-9-CM codes V42.7, 50.5 or CPT codes 47135, 47136). For patients without AdvLD, the index date was the first HCV diagnosis date observed at least 6 months after the first enrollment date, and at least 6 months of continuous enrollment after the index date were required. HCV patients without AdvLD were stratified into those with and without compensated cirrhosis (ICD-9-CM codes 571.2, 571.5, 571.6). For patients with AdvLD, the index date was the date of the first AdvLD diagnosis observed at least 6 months after the first enrollment date, and at least 1 day of enrollment after the index date was required. Cases were matched in an approximate 1:10 ratio to comparison patients without an HCV diagnosis or AdvLD diagnosis who met all other inclusion criteria based on gender, age, hospital referral region state, pre-index health care costs, alcoholism, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and a modified Charlson Comorbidity Index. For the HCV and comparison patient cohorts, PPPY all-cause costs to the payer were calculated as total allowed charges summed across all patients divided by total patient-days of follow-up for the cohort, multiplied by 365, inflation-normalized to 2009 dollars. Because the calculation of PPPY cost generated a single value for each cohort, bootstrapping was used to generate descriptive statistics. Incremental PPPY costs for HCV patients relative to non-HCV patients were calculated as between-group differences in PPPY costs. T-tests for independent samples were used to compare costs between case and comparison cohorts.RESULTS: A total of 34,597 patients diagnosed with HCV, 78.0% with HCV without AdvLD, 4.4% with compensated cirrhosis, 12.3% with decompensated cirrhosis, 2.8% with HCC, and 2.6% with liver transplant, were matched to 330,435 comparison patients. Mean (SD) age of all HCV cases was 49.9 (8.5) years; 61.7% were male. Incremental mean (SD) PPPY costs in 2009 dollars for all HCV patients relative to comparison patients were $9,681 ($176) PPPY. Incremental PPPY costs were $5,870 ($157) and $5,330 ($491) for HCV patients without liver disease and with compensated cirrhosis, respectively. Incremental PPPY costs for patients with AdvLD were $27,845 ($965) for decompensated cirrhosis, $43,671 ($2,588) for HCC, and $93,609 ($4,482) for transplant. Incremental prescription drug costs, including the cost of antiviral drugs, were $2,739 ($37) for HCV patients overall, $2,659 ($41) for HCV without liver involvement, and $3,102 ($157) for HCV with compensated cirrhosis. These between-group differences were statistically significant at P