S.Fagiuoli(1), L. Scalone (2,3), R. Ciampichini (2), F. Fusco(2), L. Gaeta(1), A. Del Prete (1), I. Gardini (4), L.G. Mantovani (2,5)
1 Ospedali Riuniti, Bergamo
2 CHARTA Foundation, Milan
3 CESP, Research Center of Public Health, University of Milano Bicocca, Monza
4 EpaC Onlus, Liver Patient Association, Milan
5 CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples
Background and aim: The burden of Chronic Hepatic Diseases (CHDs) is little known. We aimed to assess direct cost, loss of productivity and Health Related Quality of Life (HRQoL) in CHDs patients (pts).
Material and methods: COME is a naturalistic, multicenter Cost of Illness study. Costs were retrospectively (time-horizon: 6 months) assessed from the societal perspective. Direct costs included non medical and medical costs: conventional and unconventional treatment, hospitalization, outpatient medical visits and diagnostic exams. Loss of productivity was measured for pts and caregivers. Results are expressed as €/patient-month (direct costs) and days/patient-month (loss of productivity). Pts’ HRQoL was assessed with the EQ-5D questionnaire and reported as percentage of pts with problems and as mean+SD visual analogue scale (VAS) score.
Results: We enrolled 1,088 valid pts, 62.0% male, aged 19-90 (median=60) years: 31.8% had hepatitis C, 20.4% cirrhosis, 20.3% hepatitis B, 11.9% had liver transplantation (LT), 7.8% hepatic carcinoma (HCC), 7.8% had other diseases. Overall, mean direct cost was 664.77€/patient-month. Percentage contribution of cost items: hospitalizations 50.6%; treatment 41.2%; outpatient accesses 2.7%; non medical costs 5.5%. Patients and their family caregivers lost 1.15 days/patient-month of productivity. Direct and indirect costs were lower in pts with hepatitis (258 €/patient-month; 0.5days/patient-month), increased in cirrhosis (494 €/patient-month; 1.73 days/patient-month) and HCC (1,224 €/patient-month; 1.75days/patient-month) and among transplanted pts (2,629 €/patient-month; 2.99 days/patient-month). HRQoL percentage of patients with problems: 23.8% mobility, 13.7% self-care, 28.7% usual activities, 37.5% pain/discomfort, 46.3% anxiety/depression. The mean+SD VAS was 69.1+20.8, with no relevant differences between the pts subgroups.
Conclusions: CHDs’ generates high costs to the healthcare system. The use of efficient treatments is necessary to reduce worsening of pts’ health, direct and indirect costs.