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Cost of Chronic Hepatitis B Infection in the United States

Lee, Todd A., PharmD, PhD*†‡; Veenstra, David L., PharmD, PhD§; Iloeje, Uchenna H., MD, MPH; Sullivan, Sean D., PhD§

Original Contribution

Goals: To estimate the direct medical costs associated with chronic hepatitis B (CHB) infection in the United States.

Background: Approximately 240,000 new cases of hepatitis B infection occur annually in the United States. There are estimated to be 1.25 million sufferers of CHB in the United States. However, the economic impact of these infections has not been well studied.

Study: We conducted a retrospective cohort analysis using administrative healthcare claims data to estimate costs for six health states associated with CHB infection. The six states were as follows: 1) CHB, 2) compensated cirrhosis, 3) decompensated cirrhosis, 4) liver transplantation, 5) transplant care >12 months following transplant, and 6) hepatocellular carcinoma. Patients in each health state were identified using diagnostic and procedure codes, and their utilization was tracked during their time in that health state. To estimate costs, we used reimbursed amounts and adjusted to year 2000 US$.

Results: Average annual costs for patients in each health state were as follows: CHB, $761; compensated cirrhosis, $227; decompensated cirrhosis, $11,459; liver transplant, $86,552; transplant care >12 months following transplant, $12,560; and hepatocellular carcinoma, $7,533. Medications contributed the largest proportion of costs in CHB and compensated cirrhosis disease states, while hospitalizations were the largest cost component in the other health states.

Conclusions: This analysis provides estimates of the annual costs of complications of hepatitis B infection in the United States. The most progressive health states were associated with significantly higher costs.

From the *Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL; †Center for Healthcare Studies, Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; ‡Center for Pharmacoeconomic Research, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL; §Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA; and ¶Pharmaceutical Research Institute, Bristol-Myers Squibb, Wallingford, CT.

Received for publication June 30, 2004; accepted August 4, 2004.

Supported by a grant from the Pharmaceutical Research Institute, Bristol-Myers Squibb Company.

The findings of this study and the views expressed in the article do not necessarily represent the views of the Department of Veterans Affairs or of the United States Government.

Reprints: Todd A. Lee, PharmD, PhD, Midwest Center for Health Services and Policy Research, Hines VA Hospital, PO Box 5000 (151-H), Hines, IL 60141 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.