Arch Hellen Med, 25(2), March-April 2008, 191-200
Economic evaluation of hepatitis C in Greece
J. YFANTOPOULOS,1 V. PAPAGIANNOPOULOU,1 K. KALIGEROS,2 S. MANOLAKOPOULOS,3 A. CHAROS,4 J. KOSKINAS5
Hepatitis C virus is a leading cause of chronic liver disease worldwide. Given the fact that around 170 million people in the world are chronically infected with HCV, more effective programs concerning the costs and impact of the disease are necessary.
OBJECTIVE The objective of this study was to estimate the direct cost of chronic hepatitis C in treated and untreated patients in Greece. Specifically, a cost component analysis was developed in order to assess the impact of medical utilization variables upon the annual direct cost.
METHOD A sample of 118 patients, randomly selected from three public hospitals in Greece, with chronic hepatitis C, who had either been followed up (46%) or had received treatment (54%) during the period 1997-2004 was analyzed. In order to estimate the annual direct cost of hepatitis C, detailed information on hematological, biochemical, hormonal and specific hepatitis C-related tests was recorded for each patient per visit annually, but the drug and medical cost were not estimated. To obtain a wider view of the cost variation that occurs in Greece, differentiation was made between public and private health services. Finally, in order to investigate the impact of the specific hepatitis C-related tests on the formulation of annual direct cost, the analysis distinguished between patients who were subjected to specific hepatitis C-related examinations and those who were not.
RESULTS The average annual direct cost for patients who were subjected to specific hepatitis C-related examinations was estimated to be € 403 (SD±256) per patient without treatment and € 758.1 (SD±287) per patient with treatment (P=0.749) in the public sector. The cost of specific hepatitis C-related examinations represented 64.8% of the above cost for patients without treatment, while the respective percentage for patients with treatment was estimated to be 68.8%. As far as the average annual direct cost for patients who were not subjected to specific hepatitis C-related examinations is concerned, it was found to be significantly lower and specifically € 96.9 (SD±93) per patient without treatment compared with € 127.8 (SD±66.9) per patient with treatment (P=0.277). Similarly, in the private sector the average annual direct cost for patients who were not subjected to specific hepatitis C-related exams was amounted to € 238.7 (SD±214.1) per patient without treatment and € 297.8 (SD±134.2) per patient with treatment (P=0.081). The specific hepatitis C-related examinations increased the above cost by € 419 and € 987.7, respectively, reaching € 657.7 (SD±330.8) and € 1285.5 (SD±566.4) (P=0.004).
CONCLUSIONS The study revealed differences in the annual direct cost between the public and private sectors that can be attributed to different pricing policies, while respective differences between patients who had undergone the specific examinations and those who had not, can be justified by the fact that these examinations are of paramount importance in the monitoring of the disease treatment.
Key words: Chronic hepatitis C, Direct cost, Hepatitis C-related exams, Private sector, Public sector.