ABSTRACT
INTRODUCTION: There is an increasing interest in the indirect (or non-healthcare) costs of hepatitis C virus (HCV). Areas covered: Systematic review of original studies on the non-healthcare costs of HCV published in English or Spanish between January 2000 and March 2017. 19 studies addressing non-healthcare cost of HCV were included in the analysis. All studies but one contain treatments with monotherapy or dual therapy prior to the recent introduction of innovative and highly effective direct acting antivirals (DAAs). Five studies estimate the incremental non-healthcare cost of HCV with a control group, which is regarded as high-quality methodology. The incremental annual non-healthcare costs of HCV in untreated patients compared with non-HCV patients are 4,209 in the US, and taking data from 5 European countries costs range from 280 in the UK to 659 in France. Expert commentary: Available studies may be underestimating the true burden of non-healthcare costs for HCV as they are all partial studies, mainly including absenteeism and premature mortality estimates. Moreover, there is a need for studies addressing non-healthcare costs of HCV in settings where new treatments with DAAs have been implemented, as they are probably changing the current and future burden of the disease.
Subject(s)
Absenteeism , Cost of Illness , Hepatitis C/economics , Presenteeism/economics , Sick Leave/economics , Antiviral Agents/therapeutic use , Efficiency , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/mortality , Humans , Incidence , Leisure Activities/economics , PrevalenceABSTRACT
INTRODUCTION: High prices of second-generation direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C virus (HCV) patients led to reimbursement decisions based on cost per quality-adjusted life year (QALY). Areas covered: We performed a systematic review of cost-utility analyses (CUA) comparing interventions with second-generation DAA therapies with no treatment, and with previous therapies for chronic HCV patients until July 2017. A total of 36 studies were included: 30 studies from the perspective of the healthcare payer, 3 from the societal perspective, and 3 did not report the perspective. For genotype 1, the highest number of ICER comparison corresponds to sofosbuvir (SOF) triple therapy and SOF-based combinations which reported a cost per QALY systematically ranging from negative to lower than US$100,000 when compared with no treatment or dual therapy or Simeprevir triple therapy. Expert commentary: Selected studies may be overestimating the true cost per QALY of second-generation DAAs in the treatment of HCV, mainly because of neglecting non-healthcare costs, using official list prices which are higher than actual transaction prices and not adopting the long run drug price in a dynamic approach. In addition, the impact of important price reductions of several DAAs in recent years on cost per QALY should be considered.
Subject(s)
Antiviral Agents/economics , Antiviral Agents/therapeutic use , Drug Costs , Hepacivirus/drug effects , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/economics , Antiviral Agents/adverse effects , Cost-Benefit Analysis , Drug Therapy, Combination , Genotype , Hepacivirus/genetics , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/virology , Humans , Models, Economic , Quality of Life , Sustained Virologic Response , Treatment OutcomeABSTRACT
BACKGROUND: Asthma is responsible for a large number of doctor and emergency visits due to exacerbations and inadequate control of the disease, which give rise to very high associated economic costs. The social cost of asthma comprises both the healthcare and non-healthcare costs. The purpose of this study was to analyse up-to-date estimates of the social cost of asthma, with special reference to the influence of level of severity and degree of control. METHODS: A systematic review of original cost-of-illness studies of asthma published in English or Spanish between January 2004 and December 2014 and indexed in PubMed, IBECS or IME was conducted. RESULTS: 29 cost-of-illness studies of asthma were identified, 21 of which used the societal perspective. Only 10 studies estimated the incremental cost of asthma with a control group, and none of them refers to EU countries. Of these 10, only 4 were regarded as high-quality evidence, insofar as they combined a matched control with regression models. The annual incremental cost of asthma in adults ranged from 416 to 5,317. The incremental healthcare cost of asthma increased with level of severity, from 964 for intermittent asthma to 11,703 for severe persistent asthma in adults. In adults, the incremental non-healthcare cost of asthma ranged from 136 to 3,461. CONCLUSIONS: Selected studies in this review show great heterogeneity due to different population characteristics, study designs and valuation methods, which limits their comparability. However, it can be concluded that incremental healthcare costs of asthma, compared to people without asthma, exceeds seven hundred Euros (valued in 2013) in most of the reviwed estimation for several countries. This figure is greater for studies from the United States. The incremental cost per patient increases very rapidly with level of severity and decreases with asthma patient control.
OBJETIVO: El asma supone un número elevado de consultas médicas y urgencias por exacerbaciones y control inadecuado que se traduce en elevados costes económicos. El objetivo del artículo fue conocer el coste del asma con especial referencia a la influencia del nivel de gravedad y grado de control. METODOS: Se realizó una revisión sistemática de los estudios del coste del asma originales publicados en inglés y en español entre enero de 2004 y diciembre de 2014 e indexados en PubMed, Indice bibliográfico español de ciencias de la salud e Indice Médico Español. RESULTADOS: Se identificaron 29 estudios, de los cuales 21 empleaban la perspectiva social. Solo 10 estudios estimaron el coste incremental del asma con un grupo control, ninguno de estos referido a países de la Unión Europea. De ellos 4 se pudieron considerar que producían evidencia de alta calidad al combinar una cohorte de pares (matched control) con modelos de regresión. El coste incremental anual del asma en adultos osciló entre 416 y 5.317 euros. El coste sanitario incremental del asma fue creciente con el nivel de gravedad desde 964 para el asma intermitente hasta 11.703 para el asma severo persistente en población adulta, en la que el coste no sanitario incremental del asma osciló entre 136 y 3.461 euros. CONCLUSIONES: Los estudios revisados presentan una gran heterogeneidad por la inclusión de poblaciones, diseños y métodos de valoración diferentes, lo cual limita la comparabilidad entre ellos. Sin embargo, se puede concluir que el coste sanitario incremental del asma respecto a personas sin asma supera los setecientos euros (valorados en 2013) en la mayoría de las estimaciones revisadas para los países estudiados. Esta cifra resulta más elevada en los estudios de Estados Unidos. El coste incremental por paciente crece de forma muy rápida con el nivel de gravedad y se reduce con el control clínico de las personas con asma.
Subject(s)
Asthma/economics , Cost of Illness , Adult , Canada , European Union/economics , Health Care Costs , Health Expenditures , Humans , Severity of Illness Index , Socioeconomic Factors , Spain , United StatesABSTRACT
Fundamentos: El asma supone un número elevado de consultas médicas y urgencias por exacerbaciones y control inadecuado que se traduce en elevados costes económicos. El objetivo del artículo fue conocer el coste del asma con especial referencia a la influencia del nivel de gravedad y grado de control. Método: Se realizó una revisión sistemática de los estudios del coste del asma originales publicados en inglés y en español entre enero de 2004 y diciembre de 2014 e indexados en PubMed, Indice Bibliográfico Español de Ciencias de la Salud e Indice Médico Español. Resultados: Se identificaron 29 estudios, de los cuales 21 empleaban la perspectiva social. Solo 10 estudios estimaron el coste incremental del asma con un grupo control, ninguno de estos referido a países de la Unión Europea. De ellos 4 se pudieron considerar que producían evidencia de alta calidad al combinar una cohorte de pares (matched control) con modelos de regresión. El coste incremental anual del asma en adultos osciló entre 416 y 5.317 euros. El coste sanitario incremental del asma fue creciente con el nivel de gravedad desde 964 Euros para el asma intermitente hasta 11.703 Euros para el asma severo persistente en población adulta, en la que el coste no sanitario incremental del asma osciló entre 136 y 3.461 Euros. Conclusiones: Los estudios revisados presentan una gran heterogeneidad por la inclusión de poblaciones, diseños y métodos de valoración diferentes, lo cual limita la comparabilidad entre ellos. Sin embargo, se puede concluir que el coste sanitario incremental del asma respecto a personas sin asma supera los setecientos euros (valorados en 2013) en la mayoría de las estimaciones revisadas para los países estudiados. Esta cifra resulta más elevada en los estudios de Estados Unidos. El coste incremental por paciente crece de forma muy rápida con el nivel de gravedad y se reduce con el control clínico de las personas con asma (AU)
Background: Asthma is responsible for a large number of doctor and emergency visits due to exacerbations and inadequate control of the disease, which give rise to very high associated economic costs. The social cost of asthma comprises both the healthcare and non-healthcare costs. The purpose of this study was to analyse up-to-date estimates of the social cost of asthma, with special reference to the influence of level of severity and degree of control. Methods: A systematic review of original cost-of-illness studies of asthma published in English or Spanish between January 2004 and December 2014 and indexed in PubMed, IBECS or IME was conducted. Results: 29 cost-of-illness studies of asthma were identified, 21 of which used the societal perspective. Only 10 studies estimated the incremental cost of asthma with a control group, and none of them refers to EU countries. Of these 10, only 4 were regarded as high-quality evidence, insofar as they combined a matched control with regression models. The annual incremental cost of asthma in adults ranged from Euros 416 to Euros 5,317. The incremental healthcare cost of asthma increased with level of severity, from Euros 964 for intermittent asthma to Euros 11,703 for severe persistent asthma in adults. In adults, the incremental non-healthcare cost of asthma ranged from Euros 136 to Euros 3,461. Conclusion: Selected studies in this review show great heterogeneity due to different population characteristics, study designs and valuation methods, which limits their comparability. However, it can be concluded that incremental healthcare costs of asthma, compared to people without asthma, exceeds seven hundred Euros (valued in 2013) in most of the reviwed estimation for several countries. This figure is greater for studies from the United States. The incremental cost per patient increases very rapidly with level of severity and decreases with asthma patient control (AU)
