Monday, February 6, 2006

New Analysis Reveals Nearly 30% Annual Increase in Use of Resources among HCV Patients
By Julie McKeel

DCRI researchers examined recent growth in the use of health care resources among chronic hepatitis C virus (HCV) patients, by age group, and found average annual increases of 25% to 30% for hospitalizations, costs, length of hospital stays, and visits to physician offices.

In the current study, published in Hepatology (December 2005), investigators from the DCRI and the DCRI's Center for Clinical and Genetic Economics (CCGE), analyzed inpatient data from the Healthcare Cost and Utilization Project, outpatient data from the National Ambulatory Medical Care Survey, and drug data from the Verispan Source Prescription Audit.

Chronic HCV infection affects approximately 3 million people in the U.S. and represents a substantial health care burden, as evidenced by approximately 27,000 hospitalizations and $500 million in hospital charges recently attributed to the disease.

Patients with chronic hepatitis C often don't show any symptoms for a long time, thus many individuals do not receive a diagnosis until after developing serious liver damage. Current anti-HCV treatments are expensive and produce serious, even dangerous side effects. Fully 50% of those infected with genotype 1 HCV do not respond to treatment with the standard of care.

Although the incidence of HCV infection in the U.S. has declined significantly, the existing and undiagnosed cases represent "a latent threat to public health," according to the authors of the present study.

As individuals with hepatitis C infection grow older, complications from the disease will increase and place further economic and other stresses on both public and private health care systems.

From 1994 to 2001, the HCV health care burden increased among patients aged 40 to 60 years, reflecting the natural progression of the disease. In sensitivity analysis, HCV outcome growth rates remained significant, unless more than 3 out of 4 cases were initially underreported.

The study's age group analysis suggests that health care resource use will continue to grow in the near future. The increase in the frequency of hospitalization, the length of stay, the costs, and the death rates are highest for patients in their 50s, though the growth potential is even greater as middle-aged individuals continue to age.

Also, patients co-infected with the AIDS virus (HIV) and HCV in 2001 constituted 7.5 times as many hospitalizations and incurred 2.9 times the charges in 1994, relative to all HIV hospitalizations and charges.

"Our findings highlight the urgency concerning HCV outcomes," writes lead author Dr. William Grant, of the DCRI's Center for Clinical and Genetic Economics.

Hospitalizations across racial/ethnic lines were stable, except for a slight increase among Hispanic patients. On the other hand, the percentage of visits to physician offices differed significantly across racial/ethnic lines. Racial/ethnic minorities represented nearly half of HCV-related hospitalizations yet these groups accounted less than 20% of the visits to physician offices. Similar changes were seen with respect to patient gender.

Visits to physician offices were tracked from 1996 through 2002 using the National Ambulatory Medical Care Survey (NAMCS). The NAMCS contains information reported by office-based physicians engaged in direct patient care. If HCV was indicated in any of the 3 diagnostic fields, the authors categorized the office visit as HCV-related.

In the 9 years of NAMCS data, office visits by HCV patients increased at an average annual rate of 36%. Between 1996 and 2002, the 3-year moving average rose by approximately 1 million annual office visits, from 449,800 in 1996 to 1.49 million in 2002

Determining the best care options for HCV-infected patients is an increasingly important topic. For individuals with liver cirrhosis, combination treatment using peginterferon alfa plus ribavirin has resulted in better outcomes, but treatment is effective in only about half of those with genotype 1, the most common genotype found in U.S. HCV patients.

The study authors conclude, "Our findings highlight the urgency concerning HCV outcomes. Across the United States, health care providers are using tremendous amounts of resources for HCV care."

"As the patients continue to age and the disease burden progresses, suboptimal decisions regarding HCV treatments will bring increasing opportunity costs for the health care system and society."

In addition to Dr. Grant, DCRI authors for this study include Kevin Schulman, MD, director of the Center for Clinical and Genetic Economics (CCGE), Ravi Jhaveri, MD, with the Division of Infectious Diseases, Duke Department of Pediatrics, John McHutchison, MD, with the Duke University Medical Center's Division of Gastroenterology, and Teresa Kauf, PhD, formerly of CCGE. The CCGE's Damon Seils provided editorial assistance and manuscript preparation.

This study was funded by Novartis Pharmaceuticals Corporation, of East Hanover, New Jersey

Kevin Schulman, MD

Jhaveri Ravi, MD

John McHutchinson, MD

Not pictured: William Grant, PhD, and Teresa Kauf, PhD