S. Fagiuoli1, L. Scalone2,3, R. Ciampichini2, F. Fusco2, L. Gaeta1, A. Del Prete1,
L.G. Mantovani 2,4, I. Gardini5
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 Hepatic Diseases’ (CHDs) is little known. We aimed to assess costs (direct, indirect and intangible) in patients with CHDs. The following results pertain to patients with CHDs cause from HCV.
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. Direct costs included non medical (traveling/accommodation, formal-caregiver payments) and medical costs: conventional drug and unconventional treatment, hospitalization, outpatient medical visits and diagnostic examinations. Loss of productivity was measured for patients and caregivers. Results are expressed as: €/patient-month (direct costs); days/patient-month (indirect cost). 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. Fifty percent of the 1,088 patients enrolled in the study had CHDs caused from HCV: 63.4% had chronic HC, 20.7% cirrhosis, 9.7% hepatic carcinoma (HCC), 6.2% had liver transplantation (LT). Mean direct cost was 490€/patient-month. Hospitalizations contributed to the 49.5% of direct costs; treatment contributed 40.0% of costs; outpatient accesses contributed 4.0% and non medical costs contributed to 6.4% of direct costs. Patients and their family caregivers lost 0.96 days/patient-month of productivity. Both direct and indirect costs were on average lower in patients with hepatitis (238 €/patient-month and 0.5days/patient-month), increased in patients with cirrhosis (433€/patient-month and 1.7days/patient-month) and HCC (1130€/patient-month and 1.6days/patient-month) and among patients undergoing LT (2234€/patient-month and 2.9days/patient-month). Overall, 26.0% percent of patients reported problems in walking about, 15.6% had problems with self-care, 31.1% had problems in doing usual activities, 40.9% had pain/discomfort, and 52.6% had anxiety/depression. The mean+SD VAS was 65.8+20.4.
Conclusion. High societal costs are generated from having CHDs. The use of efficient treatments is necessary to reduce worsening of patients’ health, direct and indirect costs.