4, 5 Chronic HCV infection is the leading indication for liver transplantation in the U.S., and the disease is estimated to cause ∼5,000 to 10,000 deaths each year.6, 7 Between 1999 and 2007 HCV-associated mortality increased significantly and, in 2007, the number of HCV-related deaths surpassed the number of HIV-related deaths for the first time.8 Progression of liver fibrosis does not occur at a constant rate.9 Rather, disease progression is highly variable and is accelerated by, among other factors, alcohol consumption, obesity, and metabolic syndrome.
buy MK-8669 Current treatment guidelines suggest clinicians consider withholding treatment in patients with mild fibrosis because of the low likelihood of disease progression and complications, and because of the high cost of treatment.10 However, once advanced fibrosis develops, the rate of liver-related disease progression is high: it is estimated that, each year, 10% of patients with bridging fibrosis progress to cirrhosis, and 5% of patients with XL765 cirrhosis die or undergo liver
transplantation.11 Treatment of chronic hepatitis C (CHC) is associated with significant costs and delaying or forgoing treatment incurs additional costs associated with caring for patients with advanced HCV-related liver disease. HCV infection increases healthcare costs overall,9, 12, 13 and treatment of HCC and liver transplantation are undoubtedly associated with very high healthcare costs,14 but the specific impact of the progression of liver disease on healthcare costs has not been well studied. 上海皓元医药股份有限公司 The purpose of this study was to analyze the demographic characteristics, healthcare utilization, and healthcare costs of patients with HCV in a large U.S. private insurance database as
stratified by liver disease severity: noncirrhotic liver disease (NCD), compensated cirrhosis (CC), and ESLD. CC, compensated cirrhosis; CHC, chronic hepatitis C; ESLD, endstage liver disease; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NCD, noncirrhotic liver disease; OLT, orthotopic liver transplantation; PPPM, per-patient-per-month. Medical and pharmacy claims data, enrollment information, and linked laboratory results and mortality information from commercial health plan enrollees for the period January 1, 2002 to August 31, 2010 were analyzed. Patients eligible for this analysis were commercial health plan members with both pharmacy and medical benefits who had evidence of chronic HCV infection during the patient identification period (January 1, 2003 to August 31, 2010). Specifically, to be included in the analysis patients were required to have an HCV diagnosis code based on the presence of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes during the patient identification period and at least one nondiagnostic code for HCV during the study period (in order to exclude patients who only had rule-out codes for HCV).