The societal burden of chronic liver diseases: results from the COME study

Abstract

ObjectiveChronic liver diseases (CLDs) impose a significant socioeconomic burden on patients and the healthcare system, but to what extent remains underexplored. We estimated costs and health-related-quality-of-life (HRQoL) among patients with CLDs at different stages and with different aetiologies.DesignA cost-of-illness study was conducted. Direct costs, productivity loss and HRQoL were estimated in patients with chronic hepatitis, cirrhosis hepatocellular carcinoma (HCC) or where orthotopic liver transplantation (OLT) had been performed, for hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, or in those with liver disease from other causes. Patients were retrospectively observed for 6 months. The societal perspective was adopted to calculate costs.ResultsIn total, 1088 valid patients (median age=59.5 years, 60% men) were enrolled. 61% had chronic hepatitis, 20% cirrhosis, 8% HCC and 12% underwent OLT. HCV infection was identified in 52% and HBV infection in 29% of the patients. Adjusted mean direct costs increased from <€200/patient-month in HCV-infected patients with hepatitis to >€3000/patient-month in HBV infected patients with OLT. Antiviral treatment was the cost driver in patients with hepatitis, while hospital costs were the driver in the other subgroups. Absenteeism increased from HBV-infected patients with hepatitis (0.7 day/patient-month) to patients with OLT with other aetiologies (3.7 days/patient-month). HRQoL was on average more compromised in cirrhosis and patients with HCC, than in hepatitis and patients with OLT. HBV-infected patients generated higher direct costs, patients with other aetiologies generated the highest productivity loss and HCV-infected patients reported the worst HRQoL levels.ConclusionsThe present study can be considered a benchmark for future research and to guide policies aimed at maximising the cost-effective of the interventions.

Time trends in the health care burden and mortality of acute on chronic liver failure in the United States

“…The economic burden of ACLF is conceivably much larger still when the additional costs are taken into consideration for convalescence in nursing homes and acute rehabilitation facilities, which most of these patients need after a prolonged hospitalization. Additionally, the losses derived from absenteeism and health‐related quality of life of the patient and caregivers adds significantly to the societal burden of chronic liver diseases …”

The potential of silymarin for the treatment of hepatic disorders

“…In Europe the estimated prevalence rate of NAFLD is up to 30 % in the general population (including obese children) and up to 70 % in people with type 2 diabetes. These conditions [7] generate large direct costs, loss of productivity and income and poor health-related quality of life [8].…”

Economic Burden of Hepatitis C Infection

“…This can result in additional monetary expenses, and in the loss of productivity by unpaid caregivers (families or friends). Although the latter aspect of the disease is rarely considered, 1 report suggested that it could be sometimes comparable with the productivity burden experienced by the patients themselves 93 and, thus, should be accounted for by future pharmacoeconomic studies of the disease.…”

“…97,98 Substantial absenteeism, which includes an increase in the number of sick days and time spent on short-and long-term disability leave, has been reported in multiple studies. 73,93,[99][100][101] From the study by Baran and colleagues, 99 it can be projected that employed people with HCV incur, on average, approximately $1200 per year (in 2013 US dollars) in absenteeism-related losses. That, when multiplied by the number of chronically infected individuals in the United States (2.7 million 102 ) and by the employment rate of approximately 50% cited, suggests the national annual burden of absenteeism caused by HCV of approximately $1.65 billion.…”

“…73,[93][94][95] Another contributor to that burden is impaired work productivity in patients who are employed; it includes both lost hours of work (absenteeism) and decreased productivity while working (presenteeism). 96 Physical fatigue and cognitive and emotional impairment have been shown to be the major drivers of lower work productivity in patients with HCV.…”