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Hepatitis C Attributable Healthcare Costs and Mortality among Immigrants: A Population-Based Matched Cohort Study
Aysegul Erman1,2, Yeva Sahakyan1, Karl Everett2
1Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.
Insights
Chronic hepatitis C (CHC) significantly increases mortality and healthcare costs for immigrants in Ontario. This study quanties the economic burden, aiding HCV elimination strategies for at-risk populations.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Limited data exists on the economic impact of chronic hepatitis C (CHC) among immigrant populations.
- Estimating the burden of CHC-attributable mortality and healthcare costs in immigrants is crucial for targeted interventions.
Purpose of the Study:
- To estimate the mortality rates and healthcare expenditures associated with CHC among immigrants in Ontario, Canada.
- To provide data supporting the planning and implementation of hepatitis C virus (HCV) elimination efforts.
Main Methods:
- A population-based matched cohort study was conducted using linked health administrative data.
- Immigrants diagnosed with CHC were matched 1:1 with unexposed immigrants based on demographics and propensity scores.
- Healthcare costs were calculated from a payer perspective using a phase-of-care approach, adjusted for survival.
Main Results:
- A cohort of 5,575 CHC-infected immigrants was matched with controls.
- Mortality was significantly higher in the CHC group (10.5% vs. 3.5% at 15 years; RR=2.9).
- Mean 15-year net healthcare costs adjusted for survival reached $90,448 per person, with substantial costs across different disease phases.
Conclusions:
- Immigrants with CHC experience elevated mortality and higher healthcare costs compared to their unexposed counterparts.
- These findings underscore the need for focused HCV elimination strategies targeting immigrant communities in Ontario.
- Quantifying the economic burden is essential for resource allocation in public health initiatives.
Background:
Data on the economic burden of chronic hepatitis C (CHC) among immigrants are limited. Our objective was to estimate the CHC-attributable mortality and healthcare costs among immigrants in Ontario, Canada.
Methods:
We conducted a population-based matched cohort study among immigrants diagnosed with CHC between May 31, 2003, and December 31, 2018, using linked health administrative data. Immigrants with CHC (exposed) were matched 1 : 1 to immigrants without CHC (unexposed) using a combination of hard (index date, sex, and age) and propensity-score matching. Net costs (2020 Canadian dollars) collected from the healthcare payer perspective were calculated using a phase-of-care approach and used to estimate long-term costs adjusted for survival.
Results:
We matched 5,575 exposed individuals with unexposed controls, achieving a balanced match. The mean age was 47 years, and 52% was male. On average, 10.5% of exposed and 3.5% of unexposed individuals died 15 years postindex (relative risk = 2.9; 95% confidence interval (CI): 2.6-3.5). The net 30-day costs per person were $88 (95% CI: 55 to 122) for the prediagnosis, $324 (95% CI: 291 to 356) for the initial phase, $1,016 (95% CI: 900 to 1,132) for the late phase, and $975 (95% CI: -25 to 1,974) for the terminal phase. The mean net healthcare cost adjusted for survival at 15 years was $90,448.
Conclusions:
Compared to unexposed immigrants, immigrants infected with CHC have higher mortality rates and greater healthcare costs. These findings will support the planning of HCV elimination efforts among key risk groups in the province.
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