OBJECTIVES:

To evaluate the healthcare costs for HCV infected patients by their liver disease severity in a large commercial US population.

METHODS:

A retrospective cohort analysis of the Truven Health MarketScan Database (January 2008-December 2016) was conducted for newly diagnosed HCV patients. Patients were stratified by liver disease severity: chronic HCV, cirrhosis, decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), and liver transplant, as identified by ICD-9 and ICD-10 codes. We excluded patients who received any HCV treatment as this can alter natural history of liver progression. Unadjusted and adjusted mean liver-related and all-cause medical costs per-patient-per-month (PPPM) were estimated in 2016 USD from a third payer’s perspective using generalized linear models.

RESULTS:

A total of 61,147 HCV patients were identified and of which, 86.5% had HCV only, whereas 14.3% had cirrhosis, 7.1% had DCC, 3.2% had HCC, and 1.8% received liver transplant. The mean age of the cohort was 50.4±10.8 years with 64% in the 51-65 years age category and 60.8% males. The unadjusted mean liver-related and all-cause PPPM costs were $204 and $3,159 for patients with HCV; $751 and $4,170 for cirrhosis; $3,077 and $9,204 for DCC; $6,754 and $13,506 for HCC; $7,230 and $17,017 for liver transplant patients, respectively. In the multivariate analysis after adjusting for demographics and comorbidities, the incremental liver-related and all-cause PPPM costs, relative to HCV patients, were $305 and $378 for cirrhosis patients; $1,782 and $3,739 for DCC; $3,959 and $7,138 for HCC; $5,615 and $8,668 for liver transplant patients, relative to HCV patients (all p values <0.01).

CONCLUSIONS:

The medical costs associated with infection significantly increases with the progression of liver disease.