Direct medical costs associated with the extrahepatic manifestations of Hep C

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Direct medical costs associated with the extrahepatic manifestations of Hep C
January's issue of the Alimentary Pharmacology & Therapeutics examines the direct medical costs associated with the extrahepatic manifestations of hepatitis C virus infection.

Volume 47, Issue 1
January 2018
Pages 123–128

The economic impact of extrahepatic manifestations of hepatitis C virus (HCV) infection remains unknown for France. Dr Cacoub and colleagues from France estimated the prevalence of extrahepatic manifestations of HCV and the direct medical costs associated with them.

Estimates of 13 extrahepatic manifestations prevalence were obtained from a retrospective data analysis of HCV-infected patients in a specialized center, and the baseline prevalence in the general French population, and an international systematic review.

The impact of achieving HCV cure after anti-viral therapy was applied to the French healthcare costs. Using the first approach, the team found increased prevalence rates in HCV patients compared to the general population were observed for most extrahepatic manifestations.

The researchers observed that the mean per-patient-per-year cost of these manifestations in the tertiary centre was 3296 €. In France, HCV-extrahepatic manifestations amounted to a total cost of 215 million € per year.

Using a systematic review, the team found that the mean per-patient-per-year cost was estimated to be 1117 €. The estimated total cost reduction in France associated with HCV cure was 13.9 million € for diabetes, 8.6 million € for cryoglobulinemia vasculitis, 6.7 million € for myocardial infarction, 2.4 million € for end-stage renal disease and 1.4 million € for stroke.

Dr Cacoub's team concludes, "Extrahepatic manifestations of HCV infection substantially add to the overall economic burden of the disease in France." "HCV cure after anti-viral therapy is expected to significantly reduce the total costs of managing these manifestations in France."
Aliment Pharmacol Ther 2017: 47(1): 123–128
22 December 2017

Direct medical costs associated with the extrahepatic manifestations of hepatitis C virus infection in France
P. Cacoub, M. Vautier, A. C. Desbois, D. Saadoun, Z. Younossi
First published: 18 October 2017

Introduction
Patients chronically infected by the hepatitis C virus (HCV) are at risk of developing major liver complications.[1] Up to two-thirds of HCV-infected patients also experienced extrahepatic manifestations that include HCV-related autoimmune and/or lymphoproliferative disorders, and cardiovascular, renal, metabolic and central nervous system diseases.[2-7] The link between extrahepatic manifestations and HCV infection has been demonstrated for many years for lymphoproliferative disorders (mixed cryoglobulinemia, lymphoma), whereas it became more recently evident for cardiovascular, renal and metabolic diseases.[4, 5] Nevertheless, HCV infection showed higher morbidity and mortality rates for extra-hepatic complications, while viral eradication reduced the rate of extra-hepatic complications and deaths.[3, 5]

New oral, interferon-free direct-acting anti-virals (DAA) offer opportunities to cure most patients.[1] Sofosbuvir plus ledipasvir has been shown to improve patient-reported outcomes after achieving sustained virological response (SVR).[8-10] As new all-oral interferon-free DAA regimens for HCV are approved, their effectiveness in a real-world setting and their economic impact on health systems and society require further assessment. Previous analyses have typically focused on the hepatic complications of HCV infection and have not considered the burden of extra-hepatic manifestations.[8, 11] There is a need to accurately characterise the burden of extrahepatic manifestations in HCV-infected patients, and the impact of achieving a SVR on the costs of managing these manifestations outside the United States.[12] The objective of this study was to estimate the annual direct medical costs associated with the extrahepatic manifestations of HCV infection in France.

Continue to full text: http://onlinelibrary.wiley.com/doi/10.1111/apt.14382/full

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