Economic burden of hepatitis B infection among patients with diabetes

ABSTRACT

Despite ACIP recommendation and cost-effectiveness established in those 19–59 y old diabetes patients the uptake of Hepatitis B vaccine in diabetes patients is low. There is need to highlight the impact of Hepatitis B virus (HBV) infection in diabetes patients in terms of healthcare utilization and costs to recognize the burden of HBV in this population.

This retrospective claims analysis included patients with diabetes and HBV (cases; n=1,236) and those with diabetes without HBV (controls; n=4,944), identified by ICD-9-CM diagnosis codes. Cases were matched with 4 controls using propensity score matching. Healthcare utilization and cost were compared; incremental effect of HBV infection was assessed using multivariate analysis.

In the adjusted analyses, the mean number of hospitalizations (0.6 vs 0.4), outpatient service visits (34.2 vs. 20.4), and office visits (10.9 vs. 9.8) were 41%, 68%, and 11% higher, respectively, in cases vs. controls (all p<0.05). Gastroenterologist visits (0.8 vs. 0.2) and infectious disease visits (0.1 vs. 0.0) were 80% and 18% higher in subset of case and controls with these events. Cases ($39,435) incurred $16,397 incremental total costs compared with controls ($23,038). Medical ($30,968 vs. $17,765) and pharmacy costs ($8,029 vs. $5,114) were both significantly higher for cases (p < 0.0001).

Healthcare utilization and costs were higher among patients with diabetes and HBV than in those with diabetes alone. These results provide evidence supporting the need for HBV vaccination among unvaccinated diabetes patients.

KEYWORDS:

• diabetes
• financial burden
• hepatitis B
• healthcare utilization
• costs

Disclosure of potential conflicts of interest

GK and RS were employed by the GSK group of companies at the time of the study conduct and during the development of the manuscript. GK is currently employed by CSL and reports ownership of stock options/restricted shares from the GSK group of companies and CSL. RS is now an employee of AstraZeneca and has ownership of stocks in the GSK group of companies. JS, GD, and AJK are employees of HealthCore, Inc., a wholly owned subsidiary of Anthem, Inc. DFL was an employee of HealthCore, Inc., at the time of study design and execution. DFL is now an employee of Takeda Pharmaceuticals USA, Inc.. HealthCore, Inc. received funding by the GSK group of companies to conduct the study. DFE and JS are shareholders of Anthem, Inc.

Acknowledgments

The authors thank Cheryl Jones of HealthCore, Inc., USA, Jenny Andersson of CROMSOURCE Ltd., UK on behalf of GSK Vaccines and Marie Cloes of Business and Decision Life Sciences on behalf of GSK Vaccines for editorial support, and Ning Wu, former employee of GSK Vaccines, for study support.

Parts of this study were presented in abstract and poster form at the 75^th Annual Scientific Sessions of the American Diabetes Association, Boston, Massachusetts, June 5–9, 2015.

Funding

GlaxoSmithKline Biologicals SA was the funding source and was involved in all stages of the study (GSK study ID HO-14–14386). GlaxoSmithKline Biologicals SA also took in charge all costs associated with the development and the publishing of the present manuscript.