OBJECTIVES: Considering the recent change of paradigm in chronic hepatitis C virus (HCV) infection management, this research aimed to evaluate the annual per patient healthcare costs associated to HCV management in Portugal, through a detailed analysis of healthcare resource utilization (HRU).

METHODS: A two-round national expert panel was performed with specialist physicians from gastroenterology, infectious diseases and internal medicine. In the first round, experts responded to an electronic questionnaire concerning annual HRU associated with the different stages of liver disease (irrespective of HCV therapy) and treatment monitoring during HCV therapy. The second round consisted of a focus group to validate the results obtained from the questionnaires. Disease stages considered were: fibrosis (METAVIR F0-3), compensated cirrhosis (METAVIR F4), decompensated cirrhosis, hepatocellular carcinoma and post-liver transplant (LT). Hospitalizations, medical appointments, laboratory tests and other exams were the healthcare resources considered. HCV therapy and other drugs were not taken into account. Costs were obtained multiplying mean estimates of annual HRU by unit NHS costs retrieved from official sources.

RESULTS: Elicited annual HRU costs per liver disease stage were as follows: €498 for fibrosis, €1,359 for compensated cirrhosis, €5,749 for decompensated cirrhosis, €6,347 for hepatocellular carcinoma, €2,522 for the first year post-LT and €1,698 for subsequent years. Irrespective of disease stage, the majority of costs were related to hospitalizations and medical appointments, especially for decompensated cirrhosis and hepatocellular carcinoma (≥85%). Costs for other exams where residual, with the exception of post-LT disease stages (≥20%). Treatment monitoring ranged from a low of €699 for 8-week HCV therapy in non-cirrhotic patients, to a high of €1,288 for 24-week HCV therapy in cirrhotic patients.

CONCLUSIONS: Decompensated cirrhosis and hepatocellular carcinoma were the liver disease stages with highest annual HRU costs associated to the management of HCV patients. Most of the costs incurred are furthermore related to hospitalizations and medical appointments.