Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China

Abstract

BackgroundAlthough the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease.MethodsFrom April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China.ResultsOur data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute hepatitis B) to 297.85% (for primary liver cancer) of the average annual household income in our sample. Even for patients with health insurance, direct out-of-pocket cost of all HBV-related diseases except acute hepatitis B exceeded 40.00% of the patient’s disposable household income, making it a catastrophic expenditure for the household.ConclusionHepatitis B imposes considerable economic burden on a family. Our findings will help health policy makers’ understanding of the magnitude of the economic burden of HBV-related diseases in China. Evidence from our study also contributes to our understanding of potential benefits to society from allocating more resources to preventing and treating HBV infection, as well as increasing insurance coverage in China. These findings have important policy implications for health care reform efforts currently underway in China focusing on how to reduce the burden of catastrophic disease for its citizens.

The prevalence of hepatitis B infection in central China: An adult population‐based serological survey of a large sample size

“…It means 0.7% population aged 18–74 years old in Henan, about 0.46 million people, may be had active HBV DNA replication. According to the survey of Jingjing Lu in 2013 [Lu et al, ], the directed economic disease burden may be met to 2.1 billion dollars in the future in Henan for treating the clinical Hepatitis B.…”

Prevalence and risk factors of non‐alcoholic fatty liver disease in Bangladesh

“…The few studies that have been conducted included hospitalized patients, and little information is available on the community‐based estimation of NAFLD burden. In low‐income countries like Bangladesh, hospital‐based prevalence estimates may underestimate the true burden of disease as many patients with NAFLD may never seek medical care as a result of being asymptomatic, having limited access to healthcare services, and being in fear of significant economic burden …”

Factors associated with adults' perceived need to vaccinate against hepatitis B in rural China

“…3 In a study of the economic burden of chronic hepatitis B in Beijing and Guangzhou, 4 Hu and Chen found the disease imposed a 'substantial economic burden on patients, families and the society in China urban areas'. In Shandong province, Lu et al estimated the in-patient costs of hepatitis B-related diseases ranged from $US2954 to $US10635 per patient, 5 and Zhang et al found that in Jiangsu province the direct economic costs of HBV-related diseases ranged from $US107 for out-patients to $US3193 for in-patients. 6 All these studies advocated the need for public health officials to intervene to reduce HBV-related diseases.…”