The burden of hepatitis C in Europe from the patients’ perspective: a survey in 5 countries

Vietri et al. BMC Gastroenterology 2013, 13:16 http://www.biomedcentral.com/1471-230X/13/16 RESEARCH ARTICLE Open Access The burden of hepatitis C in Europe from the patients’ perspective: a survey in 5 countries Jeffrey Vietri1*, Girish Prajapati2 and Antoine C El Khoury3 Abstract Background: Few studies have examined the impact of Hepatitis C virus (HCV) infection on patient reported outcomes in Europe. This study was conducted to assess the burden of HCV infection in terms of work productivity loss, activity impairment, health-related quality of life, healthcare resource utilization, and associated costs. Methods: The 2010 European National Health and Wellness Survey (n = 57,805) provided data. Patients reporting HCV infection in France, Germany, the UK, Italy, and Spain were matched to respondents without HCV using propensity scores. Outcome measures included the Work Productivity and Activity Impairment (WPAI) questionnaire and the Medical Outcomes Study Short Form-12 (SF-12v2) questionnaire. Subgroup analyses focused on treatment-naïve patients. Results: HCV Patients (n = 286) had more work impairment (30% vs. 18%, p < .001), more impairment in non-work activities (34% vs. 28%, p < .05), and more annual physician visits per patient (19.8 vs. 13.3, p < .001). Estimated indirect and direct costs were €2,956 (p < .01) and €495 (p < .001) higher than in matched controls, respectively. Health-related quality of life was also lower among HCV patients. Treatment-naïve HCV patients (n = 139) also reported higher work impairment (29% vs. 15%, p < .01), as well as more frequent physician visits (19.5 vs. 12.1, p < .01) than matched controls. Each treatment-naïve HCV infected patient incurred €934 in direct costs vs. €508 (p < .01 in matched controls. Employed treatment-naïve patients reported higher productivity loss per year compared to matched controls (€6,414 vs. €3,642, p < .05). Conclusion: HCV infection in Europe is associated with considerable economic and humanistic burden. This is also true of diagnosed patients who have never been treated for HCV. Keywords: Hepatitis C virus, Absenteeism, Presenteeism, Work impairment, Costs, Health status Background An estimated 160 million people are chronically infected with Hepatitis C virus (HCV) worldwide [1]. Approximately 9 million have HCV infection in Europe, with greater prevalence in the southern and eastern regions [2-6]. While the incidence of new cases is low, few patients exposed to the virus spontaneously clear the infection, so exposure typically results in chronic infection that will continue indefinitely. Many chronically infected patients do not know that they have been infected with HCV, as infection is largely asymptomatic [7]. Though chronic HCV infection does not always cause serious health consequences, patients are at greater risk * Correspondence: 1 Health Outcomes Practice, Kantar Health, Independence Way Suite 220, Princeton, NJ, USA Full list of author information is available at the end of the article for development of cirrhosis, liver failure, and hepatocellular carcinoma (HCC), all of which are associated with high morbidity and mortality [8,9]. HCV infection is the most common indication for liver transplantation in Europe, and HCV infection of the transplanted liver is common. HCV was estimated to have caused more than 86,000 deaths in Europe in 2002 [4], a figure expected to increase as the patient population reaches the age at which long-term consequences of chronic infection typically manifest [4,10-12]. The goal of treatment for HCV is sustained virologic response (SVR), when the virus cannot be detected in the blood six months after the end of treatment. Patients who achieve SVR are at much lower risk for cirrhosis and HCC than those who do not achieve virological cure [13]. However, treatment with pegylated interferon and © 2013 Vietri et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Vietri et al. BMC Gastroenterology 2013, 13:16 http://www.biomedcentral.com/1471-230X/13/16 ribavirin is often unsuccessful, and is associated with adverse events and patient burden during the course of treatment [14-16]. Newly developed treatments for HCV infection are expected to dramatically increase the rate of SVR [17], and determining whether novel treatments are cost effective requires an assessment of the burden of HCV infection, including the economic impact as well as any impairment of quality of life. Research using the US National Health and Wellness Survey (NHWS) has documented a significant burden of HCV infection on work productivity, with infected respondents missing approximately 9% of working hours in the last week, and reporting an average of 27% impairment while at work [18], and a database study found that HCV infected patients were 7.5% less productive based on work units per hour [19]. HCV is also associated with increased use of healthcare resources and increased direct healthcare costs [19-24]. The estimates of healthcare resource use vary greatly. DiBonventura et al. reported approximately 30% more physician visits among patients with diagnosed HCV infection than among propensity matched controls, with a similar trend for emergency room (ER) visits [24]. Database studies looking at costs in the year following diagnosis of HCV infection have found even larger differences. Davis et al. found that all-cause healthcare claims in HCV infected patients were, on average, almost US$21,000 in the year after diagnosis, nearly four times that in age, gender, and plan-matched controls [20], while McCombs et al. found an average cost of over US$37,000 in the year following diagnosis, which represents an incremental cost of more than US$23,000 [22]. Impaired health-related quality of life (HRQoL) in HCV population has also been documented [24-26]. However, almost all of these studies have focused on the US population, with very few studies describing the burden among HCV infected patients in Europe [26,27], and none from a patient perspective using a representative sample. The objective of this study was to quantify the burden of HCV infection with respect to work productivity, healthcare resource use, related monetary cost to society, impairment in non-work activities, and HRQoL using a broadly representative sample of European adults. Methods The National Health and Wellness Survey (NHWS; Kantar Health, New York, NY, USA), is an annual, cross-sectional survey of adults aged 18 years or older, with 57,805 respondents across France, Germany, Italy, Spain, and the UK in 2010. The NHWS is a selfadministered survey which includes questions regarding diagnosed medical conditions, experience with over-thecounter and prescription med (...truncated)