Healthcare Expenditures for the Treatment of Patients Infected with Hepatitis C Virus in Japan
Healthcare Expenditures for the Treatment of Patients Infected with Hepatitis C Virus in Japan
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DOI：
10.1007/s40273-019-00861-x
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发表时间：
2019-11-25
影响因子：
4.4
通讯作者：
Takahashi, Osamu
中科院分区：
文献类型：
--
作者：
Fukuda, Haruhisa;Yano, Yoshihiko;Takahashi, Osamu
目的近年来开发的抗丙型肝炎病毒（HCV）直接作用药物（DAA）价格昂贵。DAA的成本效益分析需要对各种HCV疾病状态进行准确的医疗保健支出估计，但很少有研究使用国家级数据进行此类估计。这项研究利用全国代表性数据来估计每种HCV疾病状态的医疗保健支出。我们从日本全国行政索赔数据库中确定了2010年4月至2018年3月期间感染HCV的所有患者。计算以下疾病状态的每月患者水平医疗保健支出：慢性丙型肝炎（CHC），代偿性肝硬化（CC），失代偿性肝硬化（DC）和肝细胞癌（HCC）。还比较了DAA治疗前和获得持续病毒学应答（SVR）后CHC和CC状态的支出。采用纵向两部分模型来估计每个州的医疗保健支出。结果在研究期间，1，564，043例患者（146，488，137患者月数据）符合纳入标准。估值年份为二零一七年。DAA前CHC、CC、DC和HCC州每例患者的平均每月医疗保健支出（95%置信区间）分别为267美元（267 -268美元）、428美元（427 -429美元）、666美元（663 -669美元）和969美元（966 -972美元）。SVR后（>= 2年），CHC和CC状态的每位患者的平均每月医疗保健支出分别为176美元（176 -177美元）和238美元（236 -240美元）。各疾病状态下医疗费用随年龄增长而增加（P < 0.05）。结论这些医疗费用估计从全国代表性的样本有潜在的应用DAA的成本效益分析。
Aim The recently developed direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infections are costly. Cost-effectiveness analyses of DAAs require accurate healthcare expenditure estimates for the various HCV disease states, but few studies have produced such estimates using national-level data. This study utilized nationally representative data to estimate the healthcare expenditure for each HCV disease state. Methods We identified all patients infected with HCV between April 2010 and March 2018 from a nationwide administrative claims database in Japan. Monthly patient-level healthcare expenditures were calculated for the following disease states: chronic hepatitis C (CHC), compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC). The expenditures for the CHC and CC states were also compared before DAA treatment and after sustained virologic response (SVR) was achieved. A longitudinal two-part model was employed to estimate the healthcare expenditures for each state. Results During the study period, 1,564,043 patients with 146,488,137 patient-months of data met the inclusion criteria. The year of valuation was 2017. The mean monthly healthcare expenditures per patient (95% confidence intervals) for the pre-DAA CHC, CC, DC, and HCC states were US$267 (US$267-268), US$428 (US$427-429), US$666 (US$663-669), and US$969 (US$966-972), respectively. The mean monthly healthcare expenditures per patient for the post-SVR (>= 2 years) CHC and CC states were US$176 (US$176-177) and US$238 (US$236-240), respectively. Healthcare expenditure increased with increasing age in all disease states (P < 0.05). Conclusions These healthcare expenditure estimates from a nationally representative sample have potential applications in cost-effectiveness analyses of DAAs.