Economic and clinical burden of viral hepatitis in California: A population-based study with longitudinal analysis

PLoS One. 2018 Apr 30;13(4):e0196452. doi: 10.1371/journal.pone.0196452. eCollection 2018.

Abstract

Background: Economic burden of HBV and HCV infection are trending upwards.

Aims: Compare hepatitis B virus (HBV) and hepatitis C virus (HCV) related hospital admission rates, charges, mortality rates, causes of death in a US population-based study.

Methods: Retrospective cohort analysis of HBV and HCV patients from the California Office of Statewide Health Planning and Development (2006-2013) database.

Results: A total of 23,891 HBV and 148,229 HCV patients were identified. Across the 8-year period, the mean increase for all-cause ($1,863 vs $1,388) and liver-related hospitalization charges ($1,175 vs $675) were significantly higher for the HBV cohort compared to the HCV cohort. HBV patients had significantly higher liver-related hospital charges per person per year than HCV patients after controlling for covariates ($123,239 vs $111,837; p = 0.002). Compared to HCV patients, adjusted mortality hazard ratio was slightly lower in HBV patients (relative risk = 0.96; 95% CI 0.94-0.99). The major causes and places of death were different. The three major causes of death for HBV were: other malignant neoplasms (35%), cardiovascular disease/other circulatory disorders (17%), and liver-related disease (15%) whereas for HCV patients were: liver-related disease (22%), other malignant neoplasms (20%), and cardiovascular disease (16%). Regarding the place of death, 53% of HBV patients and 44% of HCV patients died in hospital inpatient, respectively.

Conclusions: HBV patients incurred higher liver-related hospital charges and higher mean increase for all-cause and liver-related hospitalization charges over the 8-year period compared to HCV patients. HBV patients had slightly lower mortality rate and their major causes and places of death were noticeably different from HCV patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • California / epidemiology
  • Cost of Illness
  • Female
  • Hepacivirus
  • Hepatitis B virus
  • Hepatitis B, Chronic / economics*
  • Hepatitis B, Chronic / mortality*
  • Hepatitis C, Chronic / economics*
  • Hepatitis C, Chronic / mortality*
  • Hospitalization
  • Humans
  • Liver / virology
  • Liver Diseases / mortality
  • Liver Diseases / virology
  • Liver Neoplasms / mortality
  • Liver Neoplasms / virology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Patient Admission*
  • Patient Discharge
  • Regression Analysis
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Grants and funding

The authors received no specific funding for this work.