ECONOMIC CONSEQUENCES OF EARLY VERSUS LATE TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS C (CHC) IN THE US

Purpose: Hepatitis C virus has been a major public health concern in the United States. Disease progression of chronic hepatitis C (CHC) would cause significant financial burden. Receiving treatment for CHC prior to the onset of severe complications can reduce long-term liver-related morbidity and mortality, improve quality of life, and result in less health resource utilizations. Only a small percentage of patients are treated in time, and there is no clear understanding on economic consequences of delayed treatment.  This study aims to compare economic consequences between patients who received treatment early or late after being diagnosed.

Method: This retrospective observational study was conducted based on an integrated administrative claims database from 7/2002 to 6/2008. Patients who were diagnosed with CHC and received CHC medication were included, with at least one-year enrollment before first CHC diagnosis (index diagnosis) and after first CHC medication (defined as index date). Early treatment was defined if initial CHC medication was prescribed within 1 year of diagnosis. Total healthcare costs (including medical and pharmacy) for a year after treatment initiation were estimated. Adjusted mean costs (overall, CHC, non-CHC) were compared between early and late treatment groups by using generalized linear model (GLM) and ANCOVA estimation techniques. Variation in effect of early treatment defined by alternative time thresholds on total costs was also assessed.

Result: A total of 1997 patients were included, which was 63% male and had a mean age of 49 years (std=8). Nearly 90% (n=1790) initiated CHC treatment within one year of their first CHC diagnosis (early treatment). Overall, the unadjusted one-year healthcare cost after treatment initiation was $48,687 (std=$77,604), of which CHC cost was $30,264 (std=$26,421) and non-CHC cost was $18,423 (std=66,900). After controlling for demographic characteristics, healthcare costs before treatment, and co-morbidities, despite the increased CHC costs of $4440 (p=0.0202),  the adjusted total costs had been reduced by -$6070 (p=0.2503) and the non-CHC cost had been $10,510 lower (p=0.0205) in early treatment group,  relative to late treatment group.

Conclusion: This study showed that patients diagnosed with CHC imposed a substantial economic burden on healthcare system, and being treated earlier may help to reduce overall healthcare expense, especially the portion other than CHC itself. Further research is warranted to confirm the economic benefit of early treatment.