Salta al menu principale di navigazione Salta al contenuto principale Salta al piè di pagina del sito
FrancoAngeli Journals

Saggi, Studi e Ricerche

N. 54 (2020)

The earlier the better. The cost of health services in treating PWIDs with chronic hepatitis C: Results from a non-interventional study

DOI
https://doi.org/10.3280/mis54-2020oa10583
Inviata
22 ottobre 2020
Pubblicato
11-12-2020

Abstract

The World Health Organization (WHO) has set up the elimination of hepatitis C virus (HCV) worldwide by 2030. The main aims of this study were to evaluate in HCV positive PWIDs: 1) the cost of patient’s journey of treated subjects; 2) the cost saving induced by HCV treatment for the public health system; 3) the potential cost for a national HCV elimination plan in drug users.
We performed a non-interventional study including 1,333 PWIDs attending the Drug Abuse Units of the Public Health Service ASST Melegnano-Martesana (Milan, Italy), over one year (January–December 2017). The direct cost for the health services received by each patient during HCV treatment (excluding the cost of drug treatment) was collected using the electronic clinical database of the public health service.
In the cohort of 1,333 patients we found 257 RNA HCV-positive PWIDs, 65 of which were treated. The mean health direct cost per each treated patient was € 1,418, while the mean the annual cost for each patient in waiting list for treatment was € 214. Considering that a HCV-positive PWID may infect within 3 years from infection at least 20 other new subjects, we may suppose that a HCV treatment may save about € 30,000 for the public health system.
The study shows that HCV treatment in PWIDs can significantly reduce both individual and community health costs and that HCV elimination plans may be sustainable for the public health system by avoiding the enormous costs of the disease burden.

Riferimenti bibliografici

  1. AIFA (2019). Registri AIFA per il monitoraggio dei farmaci anti-HCV. www.aifa.gov.it/aggiornamento-epatite-c.
  2. Axelrod D.A., Schnitzler M.A., Alhamad T., Gordon F., Bloom R.D., Hess G.P., Xiao H., Nazzal M., Segev D.L., Dharnidharka V.R., Naik A.S., Lam N.N., Ouseph R., Kasiske B.L., Durand C.M., Lentine K.L. (2018). The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes. Am. J. Transplant, 18(10): 2473-2482. doi: 10.1111/ajt.14895.
  3. Bai O.G., Capone A., Marcellusi A., Mennini F.S., Favato G. (2012). Economic burden of human papillomavirus-related diseases in Italy. PLoS One, 7: e49699.
  4. Barbosa C., Fraser H., Hoeger T.J., Leib A., Havens J.R., Young A., Kral A., Page K., Evans J., Zibell J., Hariri S., Vellozzi C., Nerlander L., Ward J.W., Vickerman P. (2019). Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs. Addiction, 114(2): 2267-2278. doi: 10.111/add. 14731.
  5. Briggs A. (1999). Economics notes: handling uncertainty in economic evaluation. BMJ, 319(7202): 120.
  6. Briggs A., Claxton K., Sculpherm M. (2007). Decision modeling for health economic evaluation. New York: Oxford University Press Inc.
  7. Cousien A., Train V.C., Deuffic-Burban S., Jauffret-Roustide M., Dhersin J.S., Yazdanpanah Y. (2016). Hepatitis C treatment as prevention of viral transmission and liver-related morbidity in persons who inject drugs. Hepatology, 63(4): 1090-1101. doi: 10.1002/hep.28227.
  8. European Association of the Study of the Liver (2014). EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J. Hepatol., 60(2): 392-420. doi: 10.1016/j.jhep.2013.11.003.
  9. Fagiuoli S., Ravasio R., Lucà M.G., Baldan A., Pecere S., Vitale A., Pasulo L. (2015). Management of hepatitis C infection before and after liver transplantation. World J. Gastroenterol., 21(15): 4447-4456. doi: 10.3748/wjg.v21.i15.4447.
  10. Gardini I., Bartoli M., Conforti M., Mennini F.S., Marcellusi A., Lanati E. (2016). HCV - estimation of the number of diagnosed patients eligible for the new anti-HCV therapies in Italy. Eur. Rev. Med. Pharmacol. Sci., 20(Suppl. 1): 7-10.
  11. Gountas I., Sypsa V., Anagnostou O., Martin N., Vickerman P., Kafetzopoulos E., Hatzakis A. (2017). Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting? Addiction, 112(7):1290-1299. doi: 10.1111/add.13764.
  12. Grebely J., Dore G.J. (2017). Treatment of HCV in persons who inject drugs: treatment as prevention. Clin. Liver Dis., 9(4): 77-80.
  13. Grebely J., Dore G.J., Morin S., Rockstroh J.K., Klein M.B. (2017). Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there? J. Int. AIDS Soc., 20(1): 22146. doi: 10.7448/IAS.20.1.22146.
  14. Hellard M., Scott N., Sacks-Davis R., Pedrana A. (2018). Achieving hepatitis C elimination in Europe - To treatment scale-up and beyond. J. Hepatol., 68(3): 383-385. doi: 10.1016/j.jhep.2017.12.004.
  15. Italian Budget Law (2019). Law n. 145, 30 December 2018, art. 1, c. 291. Official Gazette. 31 December 2018.
  16. Hickman M., Dillon J.F., Elliot L., De Angelis D., Vickerman P., Foster G., Donna P., Eriksen A., Flowers P., Golberg D., Hollingworth W., Ijaz S., Liddell D., Mandal S., Martin N., Beer L.S.Z., Drysdale K., Fraser H., Glass R., Graham L., Gunson R.N., Hamilton E., Harris H., Harris M., Harris R., Heinsbroek E., Hope V., Horwood J., Inglis S.K., Inees H., Lan A., Meadows J., McAlley A., Metcalfe C., Migchelsen S., Murray A., Myring G., Palmateer N.E., Presanis A., Radley A., Ramsay M., Samartsidis P., Simmons R., Sinka K., Vost G., Ward Z., Whiteley D., Yeung A., Hutchinson S.J. (2019). Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drug (EPIToPE). A natural expteriment (protocol). BMJ Open, 29, 9(9): e029538. doi: 10.1136/bmjopen-2019-029538.
  17. Konerman M.A., Lok A.S. (2016). Hepatitis C treatment and barriers to eradication. Clin. Transl. Gastroenterol., 7(9): e193. doi: 10.1038/ctg.2016.50.
  18. Lazarus J.V., Sperle I., Maticic M., Wiessing L. (2014). A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region. BMC Infect. Dis., 14(Suppl. 6): S16. doi: 10.1186/1471-2334-14-S6-S16.
  19. Lee M.H., Yang H.I., Yuan Y., L’Italien G., Chen C.J. (2014). Epidemiology and Natural History of Hepatitis C virus infection. World J. Gastroenterol., 20(28): 9270-9280. doi: 10.3748/wjg.v20.i28.9270.
  20. Magiorkinis G., Sypsa V., Magiorkinis E., Paraskevis D., Katsoulidou A., Belshaw R., Fraser C., Pybus O.G., Hatzakis A. (2013). Integrating phylodynamics and epidemiology to estimate transmission diversity in viral epidemics. PloS Comput. Biol., 9(1): e1002876. doi: 10.1371/journal.pcbi.1002876.
  21. Marcellusi A., Viti R., Capone A., Mennini F.S. (2015). The economic burden of HCV-induced diseases in Italy. A probabilistic cost of illness model. Eur. Rev. Med. Pharmacol. Sci., 19(9): 1610-1620.
  22. Marcellusi A., Viti R., Kondili L.A., Rosato S., Vella S., Mennini F.S., PITER Collaborating group available at www.progettopiter.it (2019). Economic consequences of investing in anti-hcv antivial treatment from the Italian NHS perspective: a real world-based analysis of PITER data. Pharmacoeconomics, 37(2): 255-266.
  23. Marcellusi A., Viti R., Mecozzi A., Mennini F.S. (2016). The direct and indirect cost of diabetes in Italy: a prevalence probabilistic approach. Eur. J. Health Econ., 17(2): 139-147. doi: 10.1007/s10198-014.0660-y.
  24. Mennini F.S., Marcellusi A., Andreoni M., Gasbarrini A., Salomone S., Craxi A. (2014). Health policy model: long-term predictive results associated with the management of hepatitic C virus-induced diseases in Italy. Clinicoecon. Outcomes Res., 6: 303-310. doi: 10.2147/CEOR.S62092.
  25. Metzig C., Surey J., Francis M., Conneely J., Abubakar I., White P.J. (2017). Impact of hepatitis C treatment as prevention for people who inject drugs is sensitive to contact network structure. Sci Rep, 7(1): 1833.
  26. Molinaro S., Resce G., Alberti A., Andreoni M., D’Egidio P.P.F., Leonardi C., Nava F.A., Pasqualetti P., Villa S. (2019). Drug Alcohol Rev., 38(6): 644-655. doi: 10.1111/dar.12978.
  27. Nava F.A., Alberti A., Andreoni M., Babudieri M., Barbarini G., D’Egidio P.F., Leonardi C., Lucchini A. (2018). For a program of eradication of hepatitis C in the population at risk (drug users and convicts). Acta Biomed., 89(Suppl. 10): 33-41. doi: 10.23750/abm.v89i10-S.7968.
  28. Ponziani F.R., Gasbarrini A., Pompili M., Burra P., Fagiuoli S. (2011). Management of hepatitis C virus infection recurrence after liver transplantation: an overview. Transplant Proc., 43(1): 291-295. doi: 10.1016/j.transproceed.2010.09.102.
  29. Ponziani F.R., Mangiola F., Binda C., Zocco M.A., Gasbarrini A., Flore R. (2017). Future of liver disease in the era of directing antivirals for the treatment of hepatitis C. World J. Hepatol., 9(7): 352-367. doi: 10.4254/wjh.v9.i7.352.
  30. Rossi C., Butt Z.A., Wong S., Buxton J.A., Islam N., Yu A., Darvishian M., Gilbert M., Wong J., Chapinal N., Binka M., Alvarez M., Tyndall M.W., Krajden M., Janjua N.Z. (2018). BC Hepatitis Testers Cohort Team. J. Hepathol., 69(5): 1007-1014.
  31. Ruggeri M., Coretti S., Romano F., Kondili L.A., Vella S., Cicchetti A. (2018). Economic evaluation of the hepatitis C virus treatment extension to early-stage fibrosis patients: evidence from the PITER real-world cohort. Value Health, 21(7): 783-791.
  32. Scott N., Iser D.M., Thompson A.J., Doyle J.S., Hellard M.E. (2016). Costeffectiveness of treating chronic hepatitis C virus direct-acting antivirals in people who inject drugs in Australia. J. Gastroenterol. Hepathol., 31(4): 872-882. doi: 10.1111/jgh.13223.
  33. Stanaway J.D., Flaxman A.D., Naghavi M., Fitzmaurice C., Vos T., Abubakar I., Abu-Raddad L.J., Assadi R., Bhala N., Cowie B., Forouzanfour M.H., Groeger J., Hanafiah K.M., Jacobsen K.H., James S.L., MacLachlan J., Malekzadeh R., Martin N.K., Mokdad A.A., Mokdad A.H., Murray C.J.L., Plass D., Rana S., Rein D.B., Richardus J.H., Sanabria J., Saylan M., Shahraz S., So S., Vlassov V.V., Weiderpass E., Wiersma S.T., Younis M., Yu C., El Sayed Zaki M., Cooke G.S. (2016). The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet, 388(10049): 1081-1088. doi: 10.1016/S0140-6736(16)30579-7.
  34. Stevens E.R., Nucifora K.A., Hagan H., Jordan A.E., Uyei J., Khan B., Dombrowski K., des Jarlais D., Braithwaite R.S. (2019). Costeffectiveness and a combined intervention of syringe access and medication assisted therapy for opioid use disorders in an injection drug use population. Clin. Infect. Dis., 11 pli:ciz 726. doi: 10.1093/cid/ciz726 [Epubahead of print].
  35. Stroffolini T., D’Egidio P.F., Aceti A., Filippini P., Puoti M., Leonardi C., Almasio P.L., DAVIS Drug Addicted, HCV Prevalence in Italy an Epidemiological, Observational, Cross-Sectional, Multicenter Study Participating Centers (2012). Hepatitis C virus infection among drug addicts in Italy. J. Med. Virol., 84(10): 1608-1612. doi: 10.1002/jmv.23370.
  36. Taylor M. (2019). What is sensitivity analysis? Newmarket, UK: Hayward Medical Communications. Available from: www.medicine.ox.ac.uk/bandolier/painres/download/whatis/What_is_sens_analy.pdf. Accessed April 14, 2014.
  37. van Santen D.K., de Vos A.S., Matser A., Willemse S.B., Lindenburg K., Kretzschmar M.E., Prins M., de Wit G.A. (2016). Cost-effectiveness of hepatitis C treatment for people who inject drugs and the impact of the type of epidemic; extrapolating from Amsterdam, the Netherlands. PLoS One; 11(10): 0163488. doi: 10.1371/journal.pone.0163488.
  38. Vietri J., Prajapati G., El Khoury A.C. (2013). The burden of hepatitis C in Europe from the patients’ perspective: a survey in 5 countries. BMC Gastroenterol., 13: 16. doi: 10.1186 / 1471-230X-13-16.
  39. WHO (2016). Global report on access to hepatitis C treatment - Focus on overcoming barriers. www.who.int/hepatitis/publications/hep-caccess-report/en.
  40. WHO (2017). Global Hepatitis Report. www.who.int/hepatitis/publications/global-hepatitis-report2017/en.

Metriche

Caricamento metriche ...