COMPARISON OF TREATMENT AND INDIRECT COSTS BETWEEN HEPATITIS,CIRRHOSIS, LIVER TRANSPLANTATION AND HEPATIC CARCINOMA: RESULTS OF THE COME STUDY

(1)Francesco Fusco, (1)Luciana Scalone, (1)Roberta Ciampichini, (2)Stefano Fagioli, (3)Ivan Gardini, (4)Laura Gaeta, (2)Anna Del Prete, (1)Lorenzo G Mantovani,

(1)CHARTA Foundation, Milano; (2)Ospedali Riuniti, Bergamo; (3)EpaC ONLUS; (4)Policlinico Hospital - University of Naples Federico II, Naples Charta Foundation, Milano, Italy

OBJECTIVES: As a result of successful treatments for chronic hepatic diseases (CHDs), patients’ life expectancy, but also the diseases prevalence and costs are increasing. However, societal costs for CHDs remain little known. We assessed treatment and productivity costs of patients with CHDs in Italy.

METHODS: a naturalistic multicentre Cost-of-Illness study was conducted. Adult patients (age18 years) diagnosed with CHDs, consequently accessing at gastroenterology unit of 2 hospitals, were enrolled. Direct and indirect costs were assessed from the societal perspective, reported as mean €/patient-month (treatment cost) and mean days/patient-month of work/school/usual activities lost (productivity loss). The patients were sub-grouped according to their main condition at the enrollment: hepatitis B, hepatitis C, cirrhosis, liver transplantation, hepatic carcinoma.

RESULTS: We enrolled 1,088 valid patients, 62.0% male (N675), aged 19-90 (median60) years: 31.5% (N342) has hepatitis C, 20.3% (N220) cirrhosis, 19.8% (N216) hepatitis B, 11.9% (N129) had liver transplantation, 7.5%(N82) hepatic carcinoma, 9.0% (N99) had other hepatic diseases. Overall, their treatment cost was 278.26 €/patient-month: 96% for conventional drug treatment, 4% for unconventional treatment (homeopathy, preparation of herbs, specific diet, multi-vitamin products). Patients who received liver transplantation were the most expensive (1041.31€/patient-month), followed by hepatitis B (249 €/month), hepatitis C (167 €/month). Productivity loss corresponded to 4.9 days/patient-month, mainly by transplanted patients (8.6 days/patient-month) and those with cirrhosis (8 days/patient-month).

CONCLUSIONS: CHDs sensitively contribute to the high cost and require appropriate health technology valuations