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
Objectives: Little is known about the overall burden of chronic liver diseases (CHDs) for the healthcare third payer, patients and their families. We performed a Cost of Illness study named COME, to assess medical and non medical (e.g., travel, formal care) direct costs, loss of productivity and Health Related Quality of Life (HRQoL) in patients with CHDs. The following results pertain to patients who received liver transplantation (LT).
Methods: the COME Study was a naturalistic, multicentre, retrospective (6 months of observational period) work involving 1088 adult patients with CHDs. Costs were assessed from the societal perspective and are reported as mean €/patient-month (direct costs) and mean days lost from work/study/usual activities per patient-month . 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: 129 patients had a LT (11.8% of the total participant in the study). These patients were 72.9% male, aged 19-72 (median=57.5) years. Etiological agents responsible for LT were: HBV (36.2%), HCV (43.1%), HBV-HCV co-infection (3.4%), other etiology (17.3%). Mean direct cost were 2,628.8€/patient-month. Hospitalizations contributed to 56.4% of costs: in particular, 40.2% was generated from 11 patients who received LT during the observational period. Treatment contributed to 39.5% of costs. Outpatient (medical visits, examinations) contributed to 0.3% of costs. Non medical costs contributed to 3.7% of direct costs. Three days/patient-month of productivity was lost by the patients and their family caregivers. Thirty-four percent of patients reported problems in walking about, 12.4% had problems with self-care, 42.1% had problems in doing usual activities, 49.2% had pain or discomfort, and 40.2% had anxiety or depression. The mean+SD VAS was 69.1+20.5.
Conclusions: High societal costs are generated from having CHDs and in particular among patients with LT. The implementation of efficient treatments aimed to reduce worsening of CHDs can help to improve patients’ health and reduce societal costs.