HCV is a major reason for healthcare utilisation in the United States

Patients with hepatitis C virus (HCV) infection are significant users of healthcare services in the United States, according to research published in the online edition of Clinical Infectious Diseases. Between 2001 and 2010, inpatient care alone for these patients cost $15 billion. Use was highest and increasing among people in the “baby boomer” generation.

“Individuals with HCV infection are large users of healthcare resources,” comment the authors. “Our findings highlight the challenges and opportunities for improved care of individuals with HCV infection.”

Hepatitis C is a major public health concern in the United States, where an estimated 3.2 million individuals are living with the infection. Hepatitis C is especially prevalent in the “baby boomer” generation, born between 1945 and 1965. Between 43 and 85% of infections in this age group are undiagnosed. The seriousness of the HCV epidemic is indicated by mortality data showing that hepatitis C has outstripped HIV as a cause of death among Americans since 2007.

A team of investigators wanted to assess the impact of HCV on utilisation of healthcare resources in the US.

They therefore examined nationally representative datasets to characterise use of outpatient, emergency department and inpatient resources by adults with hepatitis C between 2001 and 2010.

Patients were stratified into three age groups: born before 1945 (older); born 1945 to 1965 (baby boomer); born after 1965 (younger).

Of the 824 million outpatient visits made between 2001 and 2010, people with hepatitis C accounted for 2.29 million (0.28%). Baby boomers accounted for three-quarters of visits by people living with hepatitis C. There was no change in the percentage of visits involving people living with hepatitis C over the ten years of the survey. Liver-related complications occurred in 4%, 8% and 10% of younger, baby boomer and older patients, respectively.

Individuals in the United States made a total of 90 million emergency department visits during the period of the study. People living with hepatitis C accounted for 72,000 of these visits (0.08%). Baby boomers accounted for 68% of visits by people living with HCV. Liver-related problems were present in 26%, 17% and 5% of older, baby boomer and younger patients, respectively.

There were 32 million inpatient admissions during the study period, and 475,000 involved people living with hepatitis C. Baby boomers accounted for 71% of admissions among people living with hepatitis C. Admissions in this age cohort of HCV patients increased by 60% over the ten years of the study, from 2.6% to 4.2% (p < 0.001).

“At the current rate, in 10 years, HCV baby boomers may account for up to 912,000 annual hospitalizations, with acuity likely to increase given the underlying progressive liver disease and high comorbidity among these patients,” comment the authors.

The proportion of admissions involving liver-related complications was 41%, 35% and 14% for older, baby boomer and younger HCV-infected patients, respectively. 

The total annual cost of providing inpatient care to people living with hepatitis C was over $15 billion. Annual inpatient charges for people with hepatitis C who had liver-related problems totaled $463 million for younger patients, $5.8 billion for baby boomers and $1.3 billion for the older age group.

People living with hepatitis C admitted to hospital without liver-related complications were disproportionately black, from low-income households and were admitted because of a mental health disorder.

“These findings highlight the burden of mental health disorders, which includes substance abuse and psychiatric illness, within this HCV-infected population,” write the investigators. “This suggests that efforts to successfully link and treat this population might require significant resources to stabilize both drug and alcohol addiction and psychiatric illness.”

The authors believe their findings show the urgency of expanding HCV testing and treatment, noting: “HCV screening is inexpensive and reliable, with evolving treatment strategies making HCV an imminently curable disease.”