A large European study has provided
valuable insights into the high economic and human costs of infection with
hepatitis C virus (HCV). Published in BMC
Gastroenterology, the research showed that HCV infection was associated
with increase in time off work due to sickness, reduced productivity at work,
poorer non-work-related activity, greater utilisation of healthcare resources
and lower health-related quality of life.
“The economic costs of HCV infection are
considerable,” write the authors. “The intangible cost of lower [health-related
quality of life] observed in this sample was also significant.”
Approximately nine million people in
Europe are infected with HCV, and the infection caused 86,000 deaths in Europe
in 2002.
Research conducted in the United States has
shown that HCV infection is associated with increased rates of sick leave and
reduced productivity in the workplace, and that the infection also has substantial
healthcare costs at the individual level.
A team of investigators wanted to establish
the impact of HCV infection from the patient perspective with respect to
productivity at work, use of healthcare resources, impairment in
non-work-related activities, monetary costs to both health systems and
society, and also
health-related quality of life.
They therefore analysed data obtained via
the 2010 European National Health and Wellness Survey. This was completed by
57,166 patients in France, Germany, the UK, Italy and Spain. Participants reporting
HCV infection were first compared to the general population and then matched
with uninfected controls with similar characteristics. Individuals with HIV or
hepatitis B virus (HBV) infection were excluded from participation.
A total of 286 participants reported that they
were infected with HCV. Thirty-six (13%) of these people were currently
undergoing HCV therapy, an additional 111 (39%) reported an earlier course of
treatment for HCV, and the remaining participants were treatment naive.
There were significant differences between
the HCV-infected participants and the controls. Individuals with HCV were older (53
vs 46 years, p < 0.001), more likely to be male (58 vs 48%, p <
0.001), more likely to smoke (46 vs 28%) and had a greater burden of
co-morbid conditions (p = 0.008).
Overall, the individuals with HCV reported
worse outcomes than the uninfected general population. These poorer outcomes included
more impairment at work and during non-work activities (p < 0.001), more use
of healthcare resources (p < 0.01), greater costs (p < 0.01) and
significantly poorer health-related quality of life (p < 0.001).
The poorer outcomes persisted when the
authors matched the HCV-infected individuals with uninfected participants with
similar characteristics.
Individuals with HCV who were in employment
missed 43% more work time than controls (8 vs 5%, p < 0.05) and had 80%
greater impairment while at work (26 vs 15%, p < 0.001).
Infection with HCV was associated with
greater costs to employers due to absenteeism (p < 0.05) and reduced
productivity (p < 0.05). In addition, HCV was associated with
greater impairment in non-work activities (34 vs 29%, p < 0.05).
People with HCV also had more visits to
their doctor per year (20 vs 13, p < 0.001), resulting in significantly
greater financial costs to health systems (p < 0.001).
The controlled analysis also showed that
individuals with HCV had significantly poorer health-related quality of life.
“Patients reporting a physician diagnosis
of HCV infection had significantly impaired work productivity, greater
impairment in non-work activities, more healthcare resource utilization, and
worse [health-related quality of life] than both the general population and
propensity-matched individuals [controls] without HCV infection,” write the
authors.
Limiting to analysis to HCV treatment-naive
individuals similarly showed that HCV infection was associated with “greater
impairment at work and more frequent physician visits, and estimated costs were
also higher”.
The investigators therefore conclude “the
humanistic and economic burden of HCV in Europe is substantial”. They suggest
“effective treatment of HCV may alleviate the work impairment associated with
HCV and lower use of healthcare resources while providing improved quality of
life for individuals”.