Healthcare expenditure of hepatitis c genotype 1 patients in the Brazilian public healthcare system

Abstract

Objective: To estimate direct healthcare costs of new hepatitis C genotype 1 (G1) patients for a year of treatment in the public Brazilian healthcare system. Methods: A retrospective cohort study of the DATASUS database was carried out. All patients with chronic and acute Hepatitis C were identified in the database in 2009 (January-June). As defined by the national guidelines, all patients initiating treatment with the pegylated forms of interferon (peg-Interferon 1a and peg-Interferon 2b) were defined as hepatitis c genotype 1 (HCV G1). The cohort was defined as all new HCV G1 patients treated from Jan-Jun 2009, with a follow-up of 12 months. Unit costs were gathered from purchase disclosures by the Brazilian Ministry of Health. Results: In 2009, there were 20.889 HCV patients under treatment in the public healthcare system with a cost of R$ 414 million (US $ 242 MM). Of these, 17,659 patients were identified as HCV G1 (85%), with 9,173 initiating treatment in 2009. The cohort was defined at 4.800 patients with a total cost of R$ 187 million per year (R$ 37,247 per patient/year). The cohort represented 83% of all new HCV patients between Jan-Jun, but accounted for over 94% of costs. The bulk of this cost (83%) accounted for medication used to treat hepatitis (peg-interferon and/or ribavirin), with 15% accounting for the treatment of adverse events. The most common resource use was related to anemia, present in over 21% of all patients. The average treatment duration was 8.9 months per patient. Conclusion: HCV treatment in Brazil is limited to few patients, with prevalence data suggesting over 3 million infected. The average treatment duration is below label recommendations. The cost of treatment, especially of adverse events, may be underestimated as patients may receive treatment in the private healthcare system, demanding further studies.