The economic burden of HCV-induced diseases in Italy. A probabilistic cost of illness model

OBJECTIVE: The hepatitis C virus (HCV) induces several pathological conditions worldwide, with a substantial medical and economic burden. The objective of this study was to estimate the average annual cost incurred by the National Health Service (NHS), as well as society, due to HCV in Italy. METHODS: A probabilistic incidence-based cost of illness model was developed to estimate an aggregate measure of the economic burden associated with HCV-induced diseases either in terms of direct or indirect costs. Indirect costs were calculated on the basis of lost productivity according to the human capital approach. A systematic literature review was carried out to identify epidemiological and economic data which were used to inform the model. Furthermore, a one-way probabilistic sensitivity analysis with 5,000 Monte Carlo simulations was performed, in order to test the robustness of the results and define the proper 95% Confidence Interval (CE). RESULTS: Overall, the total economic burden associated with HCV-induced diseases was estimated in €1.06 billion (95%CI: €0.61- €1.63). A percentage of 60.6% was associated with indirect costs (95% CI: €0.37-€0.99 billion) and 39.4% with direct costs (95% CI: €0.23-€0.65 billion). In chronic hepatitis C, cirrhosis, hepatocellular carcinoma (HCC), liver transplantation and HCV-induced deaths, an average annual economic burden amounting to €0.26 (95%CI: €0.14-€0.41), €0.56 (95%CI: €0.30-€0.89), €0.051 (95%CI: €0.0007- €0.25), €0.05 (95%CI: €0.03-€0.08) and €0.15 (95%CI: €0.07-€0.27) billion respectively, was estimated. CONCLUSIONS: Italy is one of the European countries with the highest number of people affected by chronic HCV infection, the leading cause of cirrhosis, HCC and liver-related death. HCV-induced diseases generate high costs to Italian NHS. These highly debilitating and lifethreatening complications generate a rather large amount of indirect costs for the Italian society as well.