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The burden of hepatitis C in Europe from the patients' perspective: a survey in 5 countries
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BMC Gastroenterology Jan 17 2013
Jeffrey Vietri, Girish Prajapati and Antoine Khoury
"Conclusions: The humanistic and economic burden of HCV in Europe is substantial. The pattern of results is similar among treatment-naïve patients, which suggests that the burden of treatment is not driving the elevated resource use and lower HRQoL observed in the broader sample. Effective treatment of HCV may alleviate the work impairment associated with HCV and lower use of healthcare resources, while providing improved quality of life to the individual."
Abstract (provisional)
Background
Few studies have examined the impact of Hepatitis C virus (HCV) infection on patient reported outcomes in Europe. This study was conducted to assess the burden of HCV infection in terms of work productivity loss, activity impairment, health-related quality of life, healthcare resource utilization, and associated costs.
Methods
The 2010 European National Health and Wellness Survey (n = 57,805) provided data. Patients reporting HCV infection in France, Germany, the UK, Italy, and Spain were matched to respondents without HCV using propensity scores. Outcome measures included the Work Productivity and Activity Impairment (WPAI) questionnaire and the Medical Outcomes Study Short Form-12 (SF-12v2) questionnaire. Subgroup analyses focused on treatment-naive patients.
Results
HCV Patients (n = 286) had more work impairment (30% vs. 18%, p < .001), more impairment in non-work activities (34% vs. 28%, p < .05), and more annual physician visits per patient (19.8 vs. 13.3, p < .001). Estimated indirect and direct costs were [euro sign]2,956 (p < .01) and [euro sign]495 (p < .001) higher than in matched controls, respectively. Health-related quality of life was also lower among HCV patients. Treatment-naive HCV patients (n = 139) also reported higher work impairment (29% vs. 15%, p < .01), as well as more frequent physician visits (19.5 vs. 12.1, p < .01) than matched controls. Each treatment-naive HCV infected patient incurred [euro sign]934 in direct costs vs. [euro sign]508 (p < .01 in matched controls. Employed treatment-naive patients reported higher productivity loss per year compared to matched controls ([euro sign]6,414 vs. [euro sign]3,642, p < .05).
Conclusion
HCV infection in Europe is associated with considerable economic and humanistic burden. This is also true of diagnosed patients who have never been treated for HCV.
DISCUSSION
The present study included data from a large survey of European adults with and without HCV infection across five counties, which measured outcomes through widely used validated scales. 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 HRQoL than both the general population without HCV and propensity-matched individuals without HCV infection. The economic costs of HCV infection are considerable. We estimated work-productivity impairment due to HCV costs over euro 7,500 per employed patient per year, an incremental indirect cost of almost
euro 3,000 over matched controls. Direct costs are also elevated by almost euro 500 per patient when compared to matched controls. The intangible cost of lower HRQoL observed in this sample was also significant, particularly regarding physical quality of life and health utility. HCV patients had consistently worse outcomes than matched controls across almost all outcome measures, though some measures of healthcare resource use did not reach significance. This seems to be primarily an issue of statistical power, as those that did not reach significance-ER visits and hospitalizations-were those measuring rare events experienced by a minority of respondents. A previous study using the same measures but using a larger, US sample found significant results, despite observing numerically smaller differences between HCV patients and controls [24]. Otherwise, the HRQoL decrements and work impairment observed in the present analysis are consistent with those measured in the US NHWS, and of a similar magnitude [18].
In addition to examining HCV infected patients as a whole, the present study also considered treatment-naïve patients separately. The treatment-naïve patients are an especially interesting subgroup, as they are neither burdened by the adverse events of treatment, nor benefited from a successful therapy, and so may better represent the burden of untreated HCV infection. Relative to matched controls, these patients reported greater impairment at work and more frequent physician visits, and estimated costs were also higher. Unlike treatment-experienced patients, these individuals' elevated resource use would not be due to treatment or adverse events associated with such treatment, nor would work impairments or reduced HRQoL be due to side effects. The pattern of results in this subgroup was generally consistent with the findings in the broader comparisons, with few exceptions. Treatment-naïve patients did not show significantly elevated absenteeism relative to matched controls, but the magnitude of the difference was actually larger than in the broader comparison, suggesting that this difference is simply due to a lack of power rather than a different pattern among treatment-naïve patients.
The use of propensity scoring matching ensures that none of the effects observed could be attributed to any demographic or health history variables included in the matching analyses. However, we cannot rule out the possibility that additional variables (such as prior drug use) not included in the matching may explain the observed differences in health outcomes. However, most of the likely factors (co-morbid health conditions, health behaviors, etc.) were equated by the matching procedure.
The self-report survey methodology did not allow us to verify HCV diagnosis. However, the findings coincide with those of previous studies, suggesting this HCV sample is similar to that of other, clinically-verified HCV samples. We were also unable to confirm that controls were free of HCV infection, and given that many HCV patients are unaware of the infection it is possible that HCV patients were in the control group, causing us to underestimate the impact of HCV infection. The current study did not assess reasons for healthcare resource utilization but, given the propensity score methodology, the assumption was made that the additional resources used by the HCV group were due to the virus itself, as none of the assessed demographic or non-HCV health history variables differed between the groups. Some selection bias may also be present, in that individuals who completed the survey may have differed in some meaningful way from those who did not respond. However, for such a bias to affect the conclusions, the effect of HCV would have to be different among those who chose not to complete the survey than in those who did respond, which seems unlikely. Finally, the modest number of HCV infected respondents limits the precision of the estimates of the associated burden, though this would not contribute to spurious positive findings.
Conclusions
The humanistic and economic burden of HCV in Europe is substantial. The pattern of results is similar among treatment-naïve patients, which suggests that the burden of treatment is not driving the elevated resource use and lower HRQoL observed in the broader sample. Effective treatment of HCV may alleviate the work impairment associated with HCV and lower use of healthcare resources, while providing improved quality of life to the individual.
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