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Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria
Maria Dimitrova1, Kaloyan Pavlov2, Konstantin Mitov1
1Faculty of Pharmacy, Medical University, Sofia, Bulgaria.
Insights
Hepatitis C virus (HCV)-related cirrhosis incurs substantial direct medical costs due to frequent hospitalizations and complications. This study highlights the significant financial burden on healthcare systems and patients.
Area of Science:
- Hepatology
- Health Economics
- Public Health
Background:
- Hepatitis C virus (HCV) infection is a primary driver of chronic liver disease, leading to severe outcomes like fibrosis, cirrhosis, and hepatocellular carcinoma.
- Chronic liver disease management, particularly HCV-related cirrhosis, presents significant challenges to healthcare systems globally.
Purpose of the Study:
- To conduct a comprehensive cost analysis of treating patients with chronic HCV-related cirrhosis.
- To evaluate direct medical costs from the perspectives of the National Health Insurance Fund (NHIF), the hospital, and patients.
- To assess these costs over a 3-year period (2012-2014) at a specific university hospital.
Main Methods:
- A prospective, real-life observational study involving 297 patients with chronic HCV infection and cirrhosis.
- Data collection included demographics, clinical characteristics, and healthcare resource utilization (hospitalizations, interventions, pharmacotherapy).
- A micro-costing approach was employed, utilizing NHIF and hospital tariffs, patient-reported costs, and drug pricing data. Statistical analysis included descriptive statistics and comparative tests.
Main Results:
- The cohort comprised 76% males, with 93% diagnosed as Child-Pugh A or B. Nearly all patients (97%) experienced complications, predominantly esophageal varices.
- A total of 847 hospitalizations occurred over 3 years, with an average length of stay of 17 days, and a high mortality rate of 6.90%.
- Total direct medical costs reached 1,290,533 BGN (€659,839), averaging 4,577 BGN (€2,340) per patient. A significant correlation was found between total costs and Child-Pugh score.
Conclusions:
- HCV-related cirrhosis is a resource-intensive condition associated with substantial direct medical costs.
- Increased hospitalizations and the management of severe complications contribute significantly to the economic burden.
- The findings underscore the need for efficient resource allocation and management strategies for HCV-related cirrhosis.
Objective:
HCV infection is a leading cause of chronic liver disease with long-term complications-extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital "Queen Joanna-ISUL" for 3-year period (2012-2014).
Methods:
It is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital "Queen Joanna-ISUL" for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy) were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF), hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal-Wallis, and Friedman tests were used for statistical processing.
Results:
76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839) with an average cost per patient 4,577 BGN (€2,340). Statistically significant correlation was observed between the total cost per patient from the different payers' perspective and the Child-Pugh cirrhosis score.
Conclusion:
HCV-related cirrhosis is resource demanding and sets high direct medical costs as it is related with increased hospitalizations and complications acquiring additional treatment.
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