ESTIMATING THE SOCIETAL AND FISCAL IMPACT OF PRIMARY BILIARY CHOLANGITIS IN CANADA
Author(s)
Rui Martins, MSc1, Ana Teresa Paquete, MSc1, Mark Connolly, BA, MSc, PhD2, Marvin Rock, MPH, DrPH3, Nikos Kotsopoulos, MSc, PhD1, Chong H Kim, MPH, MS, PhD4.
1Global Market Access Solutions, Chardonne, Switzerland, 2Researcher, Global Market Access Solutions LLC, Mooresville, NC, USA, 3Gilead Sciences Inc., Foster City, CA, USA, 4Gilead, Foster City, CA, USA.
1Global Market Access Solutions, Chardonne, Switzerland, 2Researcher, Global Market Access Solutions LLC, Mooresville, NC, USA, 3Gilead Sciences Inc., Foster City, CA, USA, 4Gilead, Foster City, CA, USA.
OBJECTIVES: Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease associated with morbidity and mortality. This study estimated the societal and fiscal burden of PBC-related morbidity and mortality in Canada among patients inadequately responding to first-line ursodeoxycholic acid (UDCA) and their informal caregivers, compared with individuals without PBC.
METHODS: Disease progression of PBC patients inadequately responding to UDCA was modeled from age 45 over 20 years using a cohort state-transition model with 11 health states: defined by alkaline phosphatase levels, compensated/decompensated cirrhosis, hepatocellular carcinoma, liver transplant, PBC re-emergence, and death. Published evidence on the impact of PBC health states on labor participation - employment, disability, absenteeism, presenteeism, and retirement - was applied to time spent in each state. Productivity outcomes were valued using age-specific wages and GDP per hour worked, from a Canadian societal perspective. From a fiscal perspective, foregone tax revenues due to reduced employment and productivity were captured, including public sector-specific productivity losses. UDCA and disease management costs were also considered.
RESULTS: Patients inadequately responding to UDCA and their caregivers experienced reduced labour participation, lower productivity, and higher healthcare costs versus unaffected counterparts. Over 20 years, PBC resulted in 6.4 and 4.6 productive life-years lost for patients and caregivers, respectively. Total burden per dyad reached CAD$1.42M (societal) and CAD$562K (fiscal). Patient productivity losses accounted for 43.7% of societal and 47.2% of fiscal burden. Lost tax revenues from patients and caregivers exceeded the fiscal impact of healthcare costs.
CONCLUSIONS: Results indicate PBC is associated with a substantial long-term societal (CAD$1.42M) and fiscal (CAD$562K) burden per dyad in Canada, primarily driven by productivity losses, reduced labor participation, and foregone tax revenues among patients and caregivers. These findings highlight the broader economic consequences of disease progression and suggest that interventions improving clinical outcomes may have the potential to reduce downstream societal and fiscal burden.
METHODS: Disease progression of PBC patients inadequately responding to UDCA was modeled from age 45 over 20 years using a cohort state-transition model with 11 health states: defined by alkaline phosphatase levels, compensated/decompensated cirrhosis, hepatocellular carcinoma, liver transplant, PBC re-emergence, and death. Published evidence on the impact of PBC health states on labor participation - employment, disability, absenteeism, presenteeism, and retirement - was applied to time spent in each state. Productivity outcomes were valued using age-specific wages and GDP per hour worked, from a Canadian societal perspective. From a fiscal perspective, foregone tax revenues due to reduced employment and productivity were captured, including public sector-specific productivity losses. UDCA and disease management costs were also considered.
RESULTS: Patients inadequately responding to UDCA and their caregivers experienced reduced labour participation, lower productivity, and higher healthcare costs versus unaffected counterparts. Over 20 years, PBC resulted in 6.4 and 4.6 productive life-years lost for patients and caregivers, respectively. Total burden per dyad reached CAD$1.42M (societal) and CAD$562K (fiscal). Patient productivity losses accounted for 43.7% of societal and 47.2% of fiscal burden. Lost tax revenues from patients and caregivers exceeded the fiscal impact of healthcare costs.
CONCLUSIONS: Results indicate PBC is associated with a substantial long-term societal (CAD$1.42M) and fiscal (CAD$562K) burden per dyad in Canada, primarily driven by productivity losses, reduced labor participation, and foregone tax revenues among patients and caregivers. These findings highlight the broader economic consequences of disease progression and suggest that interventions improving clinical outcomes may have the potential to reduce downstream societal and fiscal burden.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR86
Topic
Economic Evaluation, Patient-Centered Research, Study Approaches
Disease
Gastrointestinal Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Rare & Orphan Diseases, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)