A retrospective study assessing the clinical outcomes and costs of acute hepatitis A in Cape Town, South Africa

Abstract

Background While some evidence has been demonstrated the cost-effectiveness of routine hepatitis A vaccination in middle-income countries, the evidence is still limited in other settings including in South Africa. Given this, the evidence base around the cost of care for hepatitis A needs to be developed towards considerations of introducing hepatitis A vaccines in the national immunisation schedule and guidelines. Objectives To describe the severity, clinical outcomes, and cost of hepatitis A cases presenting to two tertiary healthcare centers in Cape Town, South Africa. Methods We conducted a retrospective folder review of patients presenting with hepatitis A at two tertiary level hospitals providing care for urban communities of metropolitan Cape Town, South Africa. Patients included in this folder review tested positive for hepatitis A immunoglobulin M between 1 January 2008 and 1 March 2018. Results In total, 239 folders of hepatitis A paediatric patients < 15 years old and 212 folders of hepatitis A adult patients $$\ge$$ ≥ 15 years old were included in the study. Before presenting for tertiary level care, more than half of patients presented for an initial consultation at either a community clinic or general physician. The mean length of hospital stay was 7.45 days for adult patients and 3.11 days for paediatric patients. Three adult patients in the study population died as a result of hepatitis A infection and 29 developed complicated hepatitis A. One paediatric patient in the study population died as a result of hepatitis A infection and 27 developed complicated hepatitis A, including 4 paediatric patients diagnosed with acute liver failure. The total cost per hepatitis A hospitalisation was $1935.41 for adult patients and $563.06 for paediatric patients, with overhead costs dictated by the length of stay being the largest cost driver. Conclusion More than 1 in every 10 hepatitis A cases (13.3%) included in this study developed complicated hepatitis A or resulted in death. Given the severity of clinical outcomes and high costs associated with hepatitis A hospitalisation, it is important to consider the introduction of hepatitis A immunisation in the public sector in South Africa to potentially avert future morbidity, mortality, and healthcare spending.

Hepatitis A virus seroprevalence among children and adolescents in a high-burden HIV setting in urban South Africa

“…Our 13 Further to the high cost and morbidity/mortality, Bruckmann et al showed that HAV is currently the leading cause of paediatric acute liver failure requiring transplantation in South Africa, with even further expenses and disease burden to the health sector. 14 The study was limited by participant enrolment in a single urban centre.…”

Hepatitis A virus seroprevalence among children and adolescents in a high-burden HIV setting in urban South Africa

“…Patterson et al reviewed patients presenting with hepatitis A at tertiary level hospitals Cape Town, South Africa, and calculated the total cost per hepatitis A hospitalization of $1935.41 for adult patients and $563.06 for pediatric patients. Furthermore, more www.nature.com/scientificreports/ than 1 in every 10 hepatitis A cases (13.3%) developed complicated hepatitis A or resulted in death 13 . Further to the high cost and morbidity/mortality, Bruckmann et al showed that HAV is currently the leading cause of pediatric acute liver failure requiring transplantation in South Africa, with even further expenses and disease burden to the health sector 14 .…”

Modelling the Cost-Effectiveness of Hepatitis A in South Africa

“…The cost inputs displayed in Table 3 for hepatitis A outpatient and inpatient treatment at tertiary healthcare facilities were taken from Patterson et al 2022 [ 21 ]. The cost of liver transplant was broken down into treatment of transplant cases and cost of transplant procedures at tertiary healthcare facilities.…”