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Abstract and Introduction
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.
Introduction
Hepatitis C virus (HCV) infection is a global health problem, with approximately 3% of the world's population infected. Chronic HCV infection is a leading cause of end-stage liver disease, including cirrhosis and hepatocellular carcinoma (HCC). In developed countries, HCV infection and its long-term sequelae are now the leading cause of liver transplantation. The Centers for Disease Control and Prevention (CDC) predict that HCV-related mortality may double or triple over the next 10–20 years.
HCV infection accounts for an economic, as well as a health burden. The direct medical costs of HCV have been estimated, but the costs associated with patient and caregiver time, travel, and other incidental costs, have not. Time spent travelling to and from care, waiting for appointments, receiving consultation from providers, and receiving services or procedures represents time that could have instead been spent in productive work and enjoyable leisure activities. Fees for visits and tests, travel, childcare and non-prescription medications can be costly, especially for those with low incomes.
This study was conducted in the province of British Columbia, in Canada. Most healthcare in Canada is delivered through a publicly funded healthcare system organized at the level of the province or territory. All residents of Canada are eligible for publicly funded health insurance. In the province of British Columbia, the Medical Services Plan (MSP) insures medically required services provided by physicians and many other healthcare practitioners, as well as emergency department visits, hospitalizations, laboratory services and diagnostic and therapeutic procedures with no copayments. However, similar to the other provinces of Canada, MSP does not provide coverage for many allied health professional services or outpatient prescription medications. BC PharmaCare, a branch of the Ministry of Health's Pharmaceutical Services Division, provides assistance, based on personal income, with the cost of eligible outpatient prescription drugs and designated medical supplies, but patients must pay out-of-pocket (OOP) for the portions not covered by the province. The Ministries of Health of the other Canadian provinces and territories have similar programs to BC Pharmacare for their residents. Many people in Canada have supplemental insurance from a private insurance company which is offered by employers or purchased personally to cover healthcare services not covered by the provincial universal plan. Costs which are not covered by publicly funded or supplemental insurance plans represent an important and largely unmeasured component of the burden of HCV illness from the perspectives of society, employers, patients, and their caregivers. In this study, we evaluated patient time costs, caregiver time costs, and OOP expenses in a community-dwelling sample of patients across the continuum of HCV-related liver disease.
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