Hepatitis C and hepatitis C-related advanced liver disease hospitalisation trends before and after the Strategic Plan for Tackling Hepatitis C in the National Health System

Abstract

Introduction This work evaluates the burden and trends of hepatitis C virus (HCV)-associated hospitalisations in Spain before and after the implementation of the Strategic Plan for Tackling Hepatitis C in the National Health System in 2015. Methods HCV-related hospitalisation discharges from 2005 to 2017 were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed. Results From 2005 to 2017, there were 674 067 HCV-related hospitalisations: 1.2%, 29.9%, 63.9% and 5% of them due to acute, carriers, chronic and unspecified hepatitis C. Average age of the patients was 57.7 years (SD: 16.4), average hospital stay was 9.1 days (SD: 12.2) and intra-hospital case-fatality rate was 6.5%. Hospitalisation rates decreased notably (P < 0.05) in 2016–2017 compared to 2005–2015 for all [hospitalisation rate ratio (HRR): 0.77], males (HRR: 0.80), females (HRR: 0.74), chronic hepatitis C (HRR: 0.84), non-advanced liver disease (N-AdLD) (HRR: 0.80) and AdLD (HRR: 0.73). Acute HCV (HRR: 0.54) and carriers (HRR: 0.49) show decreases in 2016–2017 vs. 2005–2015, although their rates started to decrease in 2008/2009. Unspecified HCV hospitalisation rates increased (P < 0.05) in 2016–2017 (HRR: 2.02) vs. 2005–2015. From 2015 to 2017, cost per patient increased from 5981 euros to 6349 euros, but overall cost decreased, as hospitalisations rates decreased from 302 to 264 million euros. Discussion HCV-related hospitalisation rates decreased notably in 2016 and 2017 after the strategic plan for tackling hepatitis C was launched. Although cost per AdLD patient increased in 2016 and 2017, globally costs were reduced around 35 million euros per year.

Reduction in hepatitis C‐related hospitalizations after the implementation of the Strategic Plan for Tackling Hepatitis C in the Spanish National Health System: regional level differences

“…Results actualization of our previous study 11 including year 2018 shows that national hospitalization rates continued decreasing with the ongoing yearly implementation of treatments for hepatitis C patients by the regions. For example, in the case of all chronic HCV‐related hospitalizations, they decreased another 6.2% compared to 2017 HR (HR changed from 88.5 in 2017 to 83.0 hospitalizations per 100,000 population in 2018).…”

“…Hospitalizations were classified as N‐AdLD when chronic HCV with no coma specific codes were used for ICD‐9 (070.54, 070.7, 070.70 or V02.62) or ICD‐10 (B18.2, B19.2, B19.20 or Z22.52), and the patient did not present any other diagnosis of decompensated cirrhosis (including a separate/later diagnosed coma during the hospitalization code), hepatocellular carcinoma or liver transplant. Similar definitions have been used in previous studies 11,12 …”

“…Recently, our group presented the changes on HCV‐related hospitalizations rates at national level after the Strategic Plan implementation 11 . HCV‐related hospitalization rates decreased 20% for N‐AdLD and 27% for AdLD compared to 2005–2015 period showing a greater impact in those patients with more severe disease.…”

“…Some of the limitations of the data used for this study are described in our prior analysis, as the change of ICD‐9 to ICD‐10 that entered into force in 2016 in Spain for the National Registry of Hospitalisation 11 . ICD‐10 does not include the carrier code, and although it was provided a temporal code for 2016 and 2017, it ended disappearing in 2018 when coding was finally adapted to hepatitis C international definition.…”

“…At National level and up to 2015, an increasing trend in hospitalization rates due to accumulation and progression of hepatitis C chronic cases was reported in studies 9,10 . Garrido‐Estepa et al 11 recently updated the HCV‐related hospitalization trends using the same National Hospitalisation Registry. The study showed that HCV chronic hospitalization rates decreased after the Strategic Plan implementation in 2015: 20% in those with non‐advanced liver disease (N‐AdLD) and 27% in those with AdLD HCV‐related hospitalizations in 2016–2017 period (compared to 2005–2015).…”