People with
hepatitis C virus (HCV) infection are significant users of healthcare services
in the United States, according to research published in the online edition of Clinical Infectious Diseases. Between
2001 and 2010, inpatient care alone for these patients cost $15 billion. Use was highest
and increasing among patients in the “baby boomer” generation.
“Individuals with
HCV infection are large users of healthcare resources,” comment the authors.
“Our findings highlight the challenges and opportunities for improved care of
individuals with HCV infection.”
HCV is a major
public health concern in the United States, where an estimated 3.2 million individuals
are living with the infection. HCV is especially prevalent in the “baby boomer”
generation, born between 1945 and 1965. Between 43 and 85% of infections in this age
group are undiagnosed. The seriousness of the HCV epidemic is indicated by
mortality data showing that HCV has outstripped HIV as a cause of death among
Americans since 2007.
A team of
investigators wanted to assess the impact of HCV on utilisation of healthcare
resource in the US.
They therefore
examined nationally representative datasets to characterise use of outpatient,
emergency department and inpatient resources by adults living with hepatitis C between
2001 and 2010.
Patients were
stratified into three age groups: born before 1945 (older); born 1945 to 1965 (baby
boomer); born after 1965 (younger).
Of the 824 million
outpatient visits made between 2001-2010, patients with HCV infection accounted
for 2.29 million (0.28%). Baby boomers accounted for three-quarters of the
visits by HCV-infected patients. There was no change in the percentage of
visits involving patients with HCV over the ten years of the survey.
Liver-related complications occurred in 4%, 8% and 10% of younger, baby boomer
and older patients, respectively.
Individuals in the
United States made a total of 90 million emergency department visits during the
period of the study. Patients with HCV accounted for 72,000 of these visits
(0.08%). Baby boomers accounted for 68% of visits by patients with HCV.
Liver-related problems were present in 26%, 17% and 5% of older, baby boomer
and younger patients, respectively.
There were 32
million inpatient admissions during the study period, and 475,000 involved
patients with HCV. Baby boomers accounted for 71% of admissions among the
HCV-infected patients. Admissions in this age cohort of HCV patients increased
by 60% over the ten years of the study, from 2.6% to 4.2% (p < 0.001).
“At the current
rate, in 10 years, HCV baby boomers may account for up to 912,000 annual
hospitalizations, with acuity likely to increase given the underlying
progressive liver disease and high comorbidity among these patients,” comment the
authors.
The proportion of
admissions involving liver-related complications was 41%, 35% and 14% for
older, baby boomer and younger HCV-infected patients, respectively.
The total annual
cost of providing inpatients care to people with HCV was over $15 billion. Annual
inpatient charges for HCV-infected patients with liver-related problems totaled
$463 million for younger patients, $5.8 billion for baby boomers and $1.3
billion for the older age group.
People with HCV admitted
to hospital without liver-related complications were disproportionately black,
from low-income households and admitted because of a mental health
disorder.
“These findings
highlight the burden of mental health disorders, which includes substance abuse
and psychiatric illness, within this HCV-infected population,” write the
investigators. “This suggests that efforts to successfully link and treat this
population might require significant resources to stabilize both drug and
alcohol addiction and psychiatric illness.”
The authors
believe their findings show the urgency of expanding HCV testing and treatment,
noting: “HCV screening is inexpensive and reliable, with evolving treatment
strategies making HCV an imminently curable disease.”