The results of this retrospective analysis demonstrate the costs associated with the care of patients with CHC are substantial and are driven largely by disease severity. The present study has several strengths. First, the definitions of liver disease severity (and associated

ICD-9 codes) were developed selleck kinase inhibitor by a consensus panel of three practicing clinical hepatologists. Second, we used actual amounts paid rather than charges to determine healthcare costs, thus reflecting a more realistic estimate of the costs of this disease in the U.S. Third, to our knowledge, no other study of patients with CHC enrolled in a U.S. managed care database has included a geographically and demographically more diverse cohort of patients (57,149), or had a longer duration of follow-up (more than 8 years). Another unique feature of our analysis is the estimate of both costs and resource

use as stratified by liver disease severity. These results demonstrate that direct all-cause healthcare costs and HCV-related healthcare costs increased as chronic HCV infection progresses, and were lowest in patients with NCD, highest in patients with ESLD, and intermediate in patients with CC. Consistent with these findings, our statistical model showed that healthcare utilization increased with progressive liver disease severity and was highest in patients with ESLD. ICG-001 The stepwise increase in direct healthcare costs with increasing liver disease severity highlights the imminent crisis that CHC infection poses in an aging population for the U.S. healthcare system. The proportion of patients with cirrhosis Resveratrol and ESLD, the incidence of HCC, and the rate of liver-related deaths are all increasing.4,

9, 17, 18 Moreover, the greatest increase in the incidence of HCC is occurring in those aged 45 to 60 years, and approximately three-quarters of HCC deaths attributable to HCV infection is occurring between the ages of 45 and 64 years.8, 18 The mean age of patients with NCD, CC, and ESLD in our analysis falls within these ranges. The subgroup analysis of patients with ESLD demonstrates that the cost of caring for patients with OLT is ∼3 times greater than in patients without OLT and the cost of caring for patients with HCC is approximately twice that of caring for patients without HCC. The results of this analysis add to previous analyses that have shown that patients with HCV infection have higher direct healthcare costs compared with patients who do not have HCV infection.9, 12, 13 Our estimate of the annual cost of caring for a patient with CHC ($24,176) is similar to that reported in other recent studies ($19,66512 to $20,9619), but greater than that reported for patients without HCV infection ($9,979).12 Our estimates of the annual cost of care for patients with ESLD and either HCC ($112,537) or OLT ($145,045) are somewhat higher than estimates in another analysis conducted on the same database. McAdam-Marx et al.