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Societal burden in patients with Chronic Hepatic Diseases

Fagiuoli Stefano1, Scalone Luciana2,3, Ciampichini Roberta2, Fusco Francesco2, Gaeta Laura1, Del Prete Anna1,  Mantovani Lorenzo G2,4 Gardini Ivan5


1 Ospedali Riuniti, Bergamo


2 CHARTA Foundation, Milan


3 CESP, Research Center of Public Health, University of Milano Bicocca, Monza


4 CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples


5 EpaC Onlus, Liver Patient Association


Background and aims:


 The burden of Chronic liver diseases’ (CHDs) is little known. We aimed to assess direct cost (medical and non medical), loss of productivity (days of work/study/doing everyday activities lost) and Health Related Quality of Life (HRQoL) in CHDs patients.


Methods:


We conducted a naturalistic, multicenter, retrospective Cost of Illness study, named COME. Costs occurring during the 6 months before enrollment were assessed from the societal perspective (i.e., healthcare third party payer, patients, their family caregivers). Direct costs included non medical costs (traveling/accommodation, formal caregiver payments) and medical costs: conventional drug  and unconventional treatment (e.g., homeopathy, herbal medicines, vitamins, etc), hospitalization for reasons attributable to hepatic condition, outpatient medical visits and diagnostic examinations.. Loss of productivity was measured for patients and caregivers. Results are expressed as €/patient-month (direct costs) and days/patient-month (loss of productivity). Patients’ HRQoL was assessed with the EQ-5D questionnaire and is reported as percentage of patients with problems and as mean+SD visual analogue scale (VAS) score.


Results:


We enrolled 1,088 valid patients, 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 hepatic diseases (cholestasis, NASH, etc.). Overall, mean direct cost was 664.77€/patient-month. Hospitalizations contributed to the 50.6% of direct costs; treatment contributed 41.2% of costs; outpatient accesses contributed 2.7% and non medical costs contributed to 5.5% of direct costs. Patients and their family caregivers lost 1.15 days/patient-month of productivity. Both direct and indirect costs were on average lower in patients with hepatitis (258 €/patient-month and 0.5days/patient-month), increased in patients with cirrhosis (494€/patient-month and 1.73days/patient-month) and HCC (1224€/patient-month and 1.75days/patient-month) and among patients undergoing LT (2629€/patient-month and 2.99days/patient-month). As regards HRQoL, 23.8% of patients reported problems in walking about, 13.7% had problems with self-care,28.7% had problems in doing usual activities, 37.5% had pain/discomfort, 46.3% complained with anxiety/depression. The mean+SD VAS was 69.1+20.8, with no relevant differences between the patients subgroups


Conclusions: CHDs’ generates high costs to the healthcare system. The use of efficient treatments is necessary to reduce worsening of patients’ health, direct and indirect costs.



Durante il congresso EASL appena concluso il nostro studio COME “Costi e qualità di vita nei pazienti con malattia epatica cronica” è stato selezionato  tra le migliaia inviati e premiato come uno dei migliori lavori scientifici dell’anno e presentato durante la conferenza stampa del congresso tenutosi a Barcellona.


Lo studio è stato successivamente presentato in forma orale, ed abbiamo già ricevuto alcune richieste di ripubblicazione da alcune università Europee.


Ascolta l’intervista del dott. S. Fagiuoli

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