Health care costs related to hepatitis B in Finland are mostly due to chronic infections: a register-based study

Abstract

Background

Finland is among the countries with low hepatitis B endemicity. We evaluate the hepatitis B-related disease and economic burden needed for evidence-based immunisation policy decision-making.

Methods

Hepatitis B-related cases in 2004–2012 were retrieved from population-based nationwide registers. We evaluated the incidence, health care resource use, health care costs, and life years lost due to hepatitis B-related outcomes. An episode of care was constructed from each individual’s hepatitis B-related events retrieved from individually linkable registers.

Results

The mean health care costs per an acute hepatitis B case were €450 (SD 240), €2030 (SD 350), and €5400 (SD 3370) in those aged 0–14, 15–64, and ≥65 years, respectively. For chronic infection, the mean cost per case among Finnish-born individuals was €990 and among foreign-born €1360. The costs per case of liver cirrhosis were €15,350 and liver cancer €19,080. In addition, the annual antiviral medication costs per case receiving antiviral medication were €4710 to €5530. Annually <10% of the chronic and approximately 20% of liver cirrhosis cases received antiviral medication. We identified annually 21 acute, 264 chronic, three liver cirrhosis, and four liver cancer cases and 63.7 life years lost due to hepatitis B per 5.3 million inhabitants. The total annual health care costs were €1.2 million of which 60% were antiviral medication costs and 86% accounted for chronic hepatitis B.

Conclusions

When planning prevention of hepatitis B infection, it is pivotal to notice that the overall disease and economic burden due to hepatitis B is mostly due to chronic infection.

Keywords:

• Hepatitis B
• incidence
• health care costs
• cost of illness

Acknowledgements

We thank Esa Ruokokoski for record linkage in the project database and Mika Lahdenkari for the assistance in the data analysis. We also thank the National Hepatitis B Vaccination Working Group set up by the Finnish Institute for Health and Welfare as a steering group of the study. Professor Martti Färkkilä is especially acknowledged for sharing his expertise.

Author contributions

TN and HS contributed to acquisition, analysis and interpretation of data and drafting the article. MN contributed to analysis and interpretation of data and critically appraised the drafts. TL contributed to acquisition, interpretation of data and drafting the article. All authors contributed to the conception and design of the study and approved the final version of the manuscript to be submitted.

Disclosure statement

The study was supported by the Finnish Institute for Health and Welfare, Finland. Tanja Nieminen, Heini Salo, Markku Nurhonen, Tuija Leino: Employer Finnish Institute for Health and Welfare (Department of Public Health and Welfare, Department of Public Health Solutions^†, Department of Health Protection^†) has had project funding from pharmaceutical industry producing vaccines (e.g. GSK). Tanja Nieminen: Present employer Medaffcon Oy has project funding from pharmaceutical industry. ^†Was part of the former organisation of the Finnish Institute for Health and Welfare.