Costs and absence of HCV-infected employees by disease stage

Abstract

Objectives:

Quantify the costs and absenteeism associated with stages of the Hepatitis C virus (HCV).

Study design:

Retrospective analysis of the HCMS integrated database from multiple geographically diverse, US-based employers with employee information on medical, prescription, and absenteeism claims.

Methods:

Employee data were extracted from July 2001–March 2013. Employees with HCV were identified by ICD-9-CM codes and classified into disease severity cohorts using diagnosis/procedure codes assigning the first date of most severe claim as the index date. Non-HCV employees (controls) were assigned random index dates. Inclusion required 6-month pre-/post-index eligibility. Medical, prescription, and absenteeism cost and time were analyzed using two-part regression (logistic/generalized linear) models, controlling for potentially confounding factors. Costs were inflation adjusted to September 2013.

Results:

All direct costs comparisons were statistically significant (p ≤ 0.05) with mean medical costs of $1813 [SE = $3] for controls (n = 727,588), $4611 [SE = $211] for non-cirrhotic (n = 1007), $4646 [SE = $721] for compensated cirrhosis (CC, n = 87), $12,384 [SE = $1122] for decompensated cirrhosis (DCC, n = 256), $33,494 [SE = $11,753] for hepatocellular carcinoma (HCC, n = 17) and $97,724 [SE = $32,437] for liver transplant (LT, n = 19) cohorts. Mean short-term disability days/costs were significantly greater for the non-cirrhotic (days = 2.03 [SE = 0.36]; $299 [SE = $53]), DCC (days = 6.20 [SE = 1.36]; $763 [SE = $169]), and LT cohorts (days = 21.98 [SE = 8.21]; $2537 [SE = $972]) compared to controls (days = 1.19 [SE = 0.01]; $155 [SE = $1]). Mean sick leave costs were significantly greater for non-cirrhotic ($373 [SE = $22]) and DCC ($460 [SE = $54]) compared to controls ($327 [SE = $1]).

Conclusions:

Employees with HCV were shown to have greater direct and indirect costs compared to non-HCV employee controls. Costs progressively increased in the more severe HCV disease categories. Slowing or preventing disease progression may avert the costs of more severe liver disease stages and enable employees with HCV to continue as productive members of the workforce.

Keywords::

• Hepatitis
• Absenteeism
• Presenteeism
• Costs of care/Healthcare expenditures
• Cirrhosis
• Liver-transplant
• Hepatocellular carcinoma

Transparency

Declaration of funding

This research was sponsored by AbbVie. RAB, JES, RW, DRW, JCS, and NLK designed the study and developed the protocol. NLK and JWY conducted the analysis. All authors participated in the interpretation of the data. RAB drafted the initial manuscript with the assistance of Conny Burkett. All authors participated in the revisions to this manuscript. RAB and JES secured the funding for this manuscript with the assistance of JCS, DRW and RWB from AbbVie.

Declaration of financial/other relationships

JCS, DRW, and RWB are AbbVie employees and may hold AbbVie stock or options. RAB and JES are employees of the JeSTARx Group., NLK and JWY at the time of this research were employees of the HCMS Group. Both the JeSTARx and HCMS Groups received funding from AbbVie to conduct this research.

Acknowledgments

Additionally, the team thanks Conny Burkett, RPh, of Paradigm Consulting, Southlake, TX, for her contributions to interpretation of the data and for assistance in drafting the manuscript. Paradigm Consulting received funding from the JeSTARx Group for their assistance.

Previous presentations

Presented at Academy Health’s 2014 Annual Research Meeting, San Diego, CA, June 10, 2014. Baran R, Samp J, Walker D, et al. The direct and indirect costs of employees with hepatitis C vary by stage of disease. Available at: http://academyhealth.org/files/ARM/photos/2014%20ARM%20Posters2.pdf (p 277–8), accessed August 14, 2014.