Baby boomers accounted for the majority of patients with hepatitis C virus who received health care in the ED and in the outpatient and inpatient settings, according to data published in Clinical Infectious Diseases.
“Individuals with HCV are large users of outpatient, ED and inpatient services with increased and rising utilization by persons born between 1945 and 1965,” James Galbraith, MD, associate professor of emergency medicine at the University of Alabama at Birmingham, told Infectious Disease News. “This not only presents a large economic burden on the health system, but more importantly highlights opportunities to identify these individuals and refer them to potentially curative treatment.”
Galbraith and colleagues used data from the National Ambulatory Medical Care Survey (NAMCS) to evaluate outpatient care, the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED care and the Nationwide Inpatient Sample (NIS) for inpatient care. The study included 10 years of data on adults from 2001 to 2010.
There were 824 million outpatient visits and 2.29 million patients (0.28%) had HCV. Baby boomers comprised 72.5% of the patients with HCV. Nearly 90 million people visited the ED and 72,138 patients (0.08%) had HCV, of which 67.7% were baby boomers. Among 31.8 million inpatient discharges, 475,224 patients (1.5%) had HCV. Among those, 70.7% were baby boomers.
During the study period, the number of outpatient visits remained stable, but the inpatient admissions increased more than 60% among baby boomers with HCV.
“This might suggest a lack of outpatient services for HCV-infected individuals or delayed HCV detection until the presence of liver disease symptoms,” Galbraith said.
The researchers found that the annual inpatient charges for baby boomers with HCV who had a liver-related complication were $5.8 billion annually. Galbraith said less than 50% of those with HCV in the study were covered by private insurance, suggesting a large burden of the costs will fall on public resources.
“An estimated 50% of people with HCV are currently unaware of their infections and are not accounted for in our study,” Galbraith said. “Our data are limited to health care visits among those with known HCV infection. Therefore, our data largely underestimate the true health care burden. This analysis reconfirms the standard of care recommendation by the CDC and the United States Prevention Services Task Force for routine HCV screening in targeted populations, including baby boomers.”
Galbraith said that they found differences between HCV inpatient discharges with and without liver disease complications. HCV discharges without liver disease complications were disproportionate among African-Americans and the uninsured and had a primary diagnosis of “mental disorder.” Galbraith said he plans to evaluate the “mental disorder” comorbidities among patients with HCV, to determine if they are classified because of substance abuse or for other disorders such as schizophrenia, depression and bipolar disorder. — by Emily Shafer
Disclosure: Two researchers report receiving grants from AbbVie, Bristol-Myers Squibb, Gilead Sciences and Vertex.