National estimates of healthcare utilization by individuals with hepatitis C virus infection in the United States

Abstract

Background: Hepatitis C virus (HCV) infection is a major public health problem in the United States. Although prior studies have evaluated the HCV-related healthcare burden, these studies examined a single treatment setting and did not account for the growing "baby boomer" population (individuals born during 1945-1965).

Methods: Data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the Nationwide Inpatient Sample were analyzed. We sought to characterize healthcare utilization by individuals infected with HCV in the United States, examining adult (≥18 years) outpatient, emergency department (ED), and inpatient visits among individuals with HCV diagnosis for the period 2001-2010. Key subgroups included persons born before 1945 (older), between 1945 and 1965 (baby boomer), and after 1965 (younger).

Results: Individuals with HCV infection were responsible for >2.3 million outpatient, 73 000 ED, and 475 000 inpatient visits annually. Persons in the baby boomer cohort accounted for 72.5%, 67.6%, and 70.7% of care episodes in these settings, respectively. Whereas the number of outpatient visits remained stable during the study period, inpatient admissions among HCV-infected baby boomers increased by >60%. Inpatient stays totaled 2.8 million days and cost >$15 billion annually. Nonwhites, uninsured individuals, and individuals receiving publicly funded health insurance were disproportionately affected in all healthcare settings.

Conclusions: Individuals with HCV infection are large users of outpatient, ED, and inpatient health services. Resource use is highest and increasing in the baby boomer generation. These observations illuminate the public health burden of HCV infection in the United States.

Keywords: emergency department; healthcare utilization; hepatitis C; infectious disease; screening.

Figure 1.

Trends in hepatitis C outpatient and emergency department visits by age cohort, 2001–2010. Outpatient data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey-Outpatient Department (NHAMCS-OPD). Emergency department data from NHAMCS-ED. 95% confidence interval estimates unavailable due to small numbers in some 2-year intervals. There was no significant change in the HCV rate for outpatient and emergency department visits in any age group.

Figure 2.

Inpatient discharge trends by age cohort and diagnosis group, 2001–2010. Data from the Nationwide Inpatient Sample. Error bars represent 95% confidence limits. Liver-related complication defined as chronic liver disease or cirrhosis, liver abscess and sequelae of chronic liver disease, other disorders of the liver, ascites, esophageal varices, hepatocellular carcinoma, or hepatorenal syndrome. Percentage change from 2001 to 2010 and test for linear trend. A, Younger, 149.1% (P < .001); baby boomer, 60.7% (P < .001); older, 23.1% (P < .001). B, Younger, 200.8% (P < .001); baby boomer, 84.4% (P < .001); older, 8.1% (P = .215). C, Younger, 141.3% (P < .001); baby boomer, 49.0% (P < .001); older, 35.3% (P < .001). D, Younger, 20.8% (P < .001); baby boomer, 14.8% (P < .001); older, –12.2% (P < .001). E, Younger, 146.2% (P < .001); baby boomer, 74.2% (P < .001); older, 44.1% (P < .001). Abbreviation: HCV, hepatitis C virus.

Figure 3.

Trends in inpatient charges by age cohort and hepatitis C virus status, 2001–2010. Data from the Nationwide Inpatient Sample. Inpatient charges inflation-adjusted to 2010 dollars using the Consumer Price Index for inpatient services. Median charge calculated with appropriate survey design weights applied. Percentage change in median charge from 2001 to 2010: A, Younger, 27.6%; baby boomer, 43.3%; older, 16.7%. B, Younger, 7.3%; baby boomer, 19.2%; older, 19.2%. Abbreviation: HCV, hepatitis C virus.