Patient time costs and out‐of‐pocket costs in hepatitis C

Abstract

Background Hepatitis C virus (HCV) infection is associated with substantial costs to patients, their caregivers and society. Aims We evaluated time costs (time spent seeking healthcare) and out‐of‐pocket (OOP) costs for patients with HCV and their caregivers. Methods We measured costs for 738 HCV outpatients in a tertiary‐care clinic using a patient‐completed questionnaire. Time and OOP costs were compared across disease stages and sociodemographic categories. We examined the association between cost and disease stage using linear regression adjusting for age, gender, marital status, education, income and Index of Coexistent Disease (ICED) comorbidity score. Costs were expressed in 2007 Canadian dollars. Results The mean annual time cost per patient was $2136 (98 h), and ranged from $281 (18 h) in individuals who had cleared the virus to $9416 in transplant recipients (420 h). Caregiver costs were reported in 10% of patients. The mean annual OOP cost per patient was $1326. Patients receiving active treatment and those with late‐stage disease spent $2500–2800 per year on HCV‐related healthcare, approximately 7% of their annual income. Patients who had cleared the virus had the lowest time and OOP costs. Low income and unemployed patients had higher costs. Conclusions In HCV‐infected individuals, OOP and time costs represent a significant economic burden and fall disproportionately upon those least able to afford them. The lower cost burden among those who were successfully treated suggests that wider use of antiviral therapy may reduce economic burden in addition to improving health outcomes.

Value in Hepatitis C Virus Treatment: A Patient-Centered Cost-Effectiveness Analysis

“…Additionally, data on time and productivity costs for HCV patients were sparse compared to the data available for direct health costs that are frequently used in CEAs for these drugs. We used published estimates for time and productivity (absenteeism and presenteeism) costs from a study of 306 HCV patients compared with propensity matched controls using the Work Productivity and Activity Impairment questionnaire [36,37]. This self-reported time and productivity loss may overestimate actual productivity losses [58].…”

“…This self-reported time and productivity loss may overestimate actual productivity losses [58]. The patient and caregiver time costs were combined to be consistent with the way in which the original study collected this information and the way results were reported in their final regression model [36]. The time costs estimates used in our analysis were from a study of 738 HCV outpatients in Canada, potentially limiting the generalizability to time costs in the US despite our conversion and inflation adjustments.…”

“…Drug costs in the first year of therapy for DAAs were estimated based off of the VA Federal Supply Schedule (VAFSS) listed for each treatment regimen for the duration of therapy for the base case [35]. Annualized maintenance costs, patient/caregiver time costs, absenteeism, and presenteeism costs were derived from previous studies of chronic HCV and adjusted to 2018 US dollars [18,19,36,37]. Patients achieving SVR were assigned lower costs for absenteeism and presenteeism, based on evidence of an HCV population compared to matched controls [37].…”

Patient perspectives on hepatitis C and its treatment

“…Important knowledge has been obtained in other medically ill populations by eliciting patient perspectives on their access to medical care and treatment experi-ences. In contrast, research to date on barriers to treatment for HCV has been conducted largely from the perspective of the physician or healthcare delivery system [20]. In contrast, research to date on barriers to treatment for HCV has been conducted largely from the perspective of the physician or healthcare delivery system [20].…”

Patient engagement and study design of PROP UP: A multi-site patient-centered prospective observational study of patients undergoing hepatitis C treatment

“…The OOP cost for patients who undergo DAA treatment is currently unknown, may vary considerably by insurance status, and is an important informational need for patients' contemplating HCV treatment 49 . The medical cost literature describes the importance of measuring both direct and indirect costs related to treatment 50 .…”