The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration.
The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration.
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按肝病阶段划分的丙型肝炎的费用：退伍军人健康管理局的估计。
DOI：
10.1007/s40258-019-00468-5
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发表时间：
2019
影响因子：
3.6
通讯作者：
Barnett,PaulG
中科院分区：
文献类型：
--
作者：
Gidwani-Marszowski,Risha;Owens,DouglasK;Lo,Jeanie;Goldhaber-Fiebert,JeremyD;Asch,StevenM;Barnett,PaulG
背景：治疗丙型肝炎病毒的高效但昂贵的药物的发布，加上丙型肝炎病毒发病率翻了一番，给许多医疗保健系统带来了巨大的财务挑战。我们提供了治疗丙型肝炎病毒患者的成本估计，这可以为在医疗资源有限的系统中进行药物治疗的分类提供信息。方法从2010财年到2014财年，我们对206,090名患有实验室确认的丙型肝炎病毒的退伍军人进行了一项观察性研究。我们估计了非晚期纤维化-4、晚期纤维化-4、肝细胞癌、肝移植和肝移植后的成本。前两个阶段是使用实验室结果数据确定的；后两个阶段是使用管理数据确定的。成本是从退伍军人健康管理局的基于活动的成本核算系统获得的，更接近于提供护理的实际成本，这是对通常表征丙型肝炎病毒成本文献的收费数据的改进。使用广义估计方程来估计和预测每个肝病阶段的成本。丢失的数据被多次归因于。结果随着患者从非晚期纤维化-4发展到晚期纤维化-4、肝细胞癌和肝移植，每年的护理费用增加(均P<；0.001)。肝移植后，费用显著降低(p<；0.001)。在模拟中，患者每年的费用估计如下：非进展期纤维化-4为17,556美元；晚期纤维化-4为20,791美元；肝癌为46,089美元；肝移植当年为261,959美元；以及US 18,643peryearafterthelivertransplant.ConclusionsCostdifferencesoftreatingnon-advancedandadvancedFibrosis-4arerelativelysmall.Thegreatestcostsavingswouldberealizedfromavoidingprogressiontolivercancerandtransplant.
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 17,556fornon-advancedFibrosis-4;US 20,791 for advanced Fibrosis-4; US 46,089forlivercancer;US 261,959 in the year of the liver transplant; and US 18,643peryearafterthelivertransplant.ConclusionsCostdifferencesoftreatingnon-advancedandadvancedFibrosis-4arerelativelysmall.Thegreatestcostsavingswouldberealizedfromavoidingprogressiontolivercancerandtransplant.