Patients With Hepatitis Delta Virus Have Higher Economic Burden Than Hepatitis B Virus Mono-Infection: Results From a Large Healthcare Provider in Israel

OBJECTIVES: This study compares the healthcare resource use (HCRU) and costs among adult patients with HDV infection vs HBV mono-infection in a large healthcare provider in Israel.

METHODS: A retrospective cohort study was performed using data from Maccabi Healthcare Services covering 1.8M adults in Israel. Diagnosis and laboratory data were used to identify HDV and HBV mono-infection (HBV-Mono) patients from 2005-2021. Adults with chronic HBV who had a Dx or positive HDV test were included in the HDV cohort (index date = HDV diagnosis). The HBV-Mono cohort comprised HBV patients tested for HDV (antibody/PCR test) without positive result or HDV diagnosis (index date = first HDV-negative result). Patients were continuously enrolled for ≥12 months pre-/post-index; patient characteristics were described at index date. All-cause HCRU and costs (using Israel Ministry of Health unit costs) per person per year were evaluated based on outpatient, inpatient and emergency room visits, and pharmacy purchases 12-months post-index using Chi-squared test and Wilcoxon rank sum test.

RESULTS: The study included 155 HDV and 2,420 HBV-Mono patients. Compared to HBV-Mono patients, HDV patients had lower socioeconomic status, and higher baseline prevalence rates for HIV (4.5% vs. 0.8%), HCV RNA+ (5.8% vs. 1.7%), and drug dependence (6.5% vs. 1.7%). More HDV patients had inpatient visits vs. HBV-Mono patients (20.6% vs. 12.0%; p=0.002), and HDV vs. HBV-Mono patients had longer median LOS for inpatient visits compared to (7.0 vs. 3.0 days; p =.0001). HDV patients had significantly greater inpatient costs ($2,240 vs $718; p<0.001), and significantly higher total costs ($5,293 vs $3,859; p=0.048).

CONCLUSIONS: In a large Israeli healthcare database, HDV patients had a greater rate of hospitalization, inpatient LOS and all-cause total healthcare costs compared to HBV-Mono patients. These findings highlight the need for effective HDV screening, diagnosis, and treatment, which may reduce its clinical and economic burden.