Study shows the high human and economic burden of HCV infection in Europe

Michael Carter
24 April 2013

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”.


Vietri J et al. The burden of hepatitis C in Europe from the patients’ perspective: a survey in 5 countries. BMC Gastroenterology 13:16, 2013.

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