Estimation of direct medical cost related to the management of chronic hepatitis C and its complications in South Korea.
Estimation of direct medical cost related to the management of chronic hepatitis C and its complications in South Korea.
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估计与慢性丙型肝炎及其在韩国并发症的管理有关的直接医疗成本。
DOI：
10.1097/md.0000000000003896
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发表时间：
2016-07
期刊：
影响因子：
1.6
通讯作者：
Paik YH
中科院分区：
文献类型：
--
作者：
Kim DY;Yoon KT;Kim W;Lee JI;Hong SH;Lee D;Jang JW;Choi JW;Kim I;Paik YH
本研究的目的是估计管理慢性丙型肝炎（CHC）及其并发症的直接医疗费用的基础上，在韩国的卫生保健资源。研究设计为多中心、回顾性、非干预性和观察性。在2013年9月至2014年4月期间，从8家机构收集了慢性丙型肝炎病毒感染患者的医疗资源数据，无论基因型如何，包括与门诊管理，急诊和住院相关的数据。观察期为2011年1月至2012年12月。疾病状态分为CHC、代偿性肝硬化（CC）、失代偿性肝硬化（DC）或肝细胞癌（HCC）。共招募了445例患者，平均年龄为60.1 ± 12.3岁。 在155例报告抗病毒治疗结果的患者中，107例（69%）出现持续病毒学应答（SVR）。未接受抗病毒治疗的患者比例为52.8%（n = 235）。 疾病状态分布为CHC 307例（69.0%），CC 75例（16.9%），HCC 45例（10.1%），DC 18例（4.0%）。所有直接医疗费用，无论是报销或不报销的国家健康保险制度，包括在内。排除每种疾病状态观察期<1个月的患者后，每月平均费用随疾病状态进展而增加（CHC：77 ± 80 USD; CC：98 ± 94 USD; DC：512 ± 1115 USD; HCC：504 ± 717 USD）。 平均每人总费用为3590 ± 8783美元，约72%的患者获得报销。 当排除44例观察期<1个月的患者时，达到SVR的CHC患者（n = 69）的每月平均医疗费用显著低于未达到SVR的CHC患者（n = 215）（42 ± 16 vs 79 ± 83 USD，P <0.001）。 有SVR的CC患者（n = 8）的费用也倾向于低于无SVR的患者（n = 70; 48 ± 20 vs 95 ± 96 USD，P = 0.177）。 抗病毒治疗费用（聚乙二醇干扰素和利巴韦林）占总医疗费用的19.0%，占处方/药房费用的53.7%。直接医疗费用随着疾病状态从CHC进展到肝硬化或HCC而增加。通过抗病毒治疗达到SVR可降低治疗费用。
This study aimed to estimate the direct medical costs of managing chronic hepatitis C (CHC) and its complications based on health-care resources in South Korea. The study design was multicenter, retrospective, non-interventional, and observational. Between September 2013 and April 2014, health-care resource data from patients chronically infected with hepatitis C virus, regardless of genotype, were collected from 8 institutions, including data related to outpatient management, emergency care, and hospitalization. The observation period was between January 2011 and December 2012. The disease state was classified as CHC, compensated cirrhosis (CC), decompensated cirrhosis (DC), or hepatocellular carcinoma (HCC). A total of 445 patients were recruited and mean age was 60.1 ± 12.3 years. Among 155 patients with reported outcomes of antiviral therapy, 107 (69%) had sustained virologic response (SVR). The rate of patients who did not receive antiviral therapy was 52.8% (n = 235). The distribution of disease state was CHC in 307 patients (69.0%), CC in 75 (16.9%), HCC in 45 (10.1%), and DC in 18 (4.0%). All direct medical costs, whether reimbursed or nonreimbursed by the National Health Insurance System, were included. After excluding patients whose observational period was <1 month for each disease status, the mean costs per month increased as disease state progressed (CHC: 77 ± 80 USD; CC: 98 ± 94 USD; DC: 512 ± 1115 USD; HCC: 504 ± 717 USD). The mean total costs per person were 3590 ± 8783 USD, and approximately 72% of patients were reimbursed. When 44 patients with an observation period <1 month were excluded, the mean medical costs per month for patients with CHC who achieved SVR (n = 69) were significantly lower than for those (n = 215) who did not (42 ± 16 vs 79 ± 83 USD, P < 0.001). The cost also tended to be lower for patients with CC with SVR (n = 8) than for those without SVR (n = 70; 48 ± 20 vs 95 ± 96 USD, P = 0.177). The cost of antiviral therapy (pegylated interferon and ribavirin) corresponded to 19.0% of total medical costs and 53.7% of prescription/pharmacy. The direct medical costs increased as disease state progressed from CHC to cirrhosis or HCC. The achievement of SVR by antiviral therapy would decrease the costs.