Costi diretti e indiretti assorbiti dalle patologie HCV-indotte in Italia: stima basata su una metodologia probabilistica di Cost of Illness

Background: 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 productivity lost according to the human capital approach. A systematic literature review was carried out to identify epidemiological and economic data which were subsequently 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 results and define the proper 95% CI. Results: Overall, the total economic burden associated with HCV-induced diseases was estimated in €1.05 (95% CI: €0.61–€1.61) billion. A percentage equal to 61.4% was associated with indirect costs (95% CI:€0.37–€0.99 billion) and 38,6% with direct costs (95% CI: €0.23–€0.63 billion). For chronic hepatitis C, cirrhosis, hepatocellular carcinoma (HCC), liver transplantation and death from causes related to HCV was estimated an average annual economic burden amounting to €0.26 (95% CI: €0.14–€0.41), €0.55 (95% CI: €0.30–€0.87), €0.051 (95% CI: €0.0001–€0.25) €0.05 (95% CI: €0.03–€0.08) and €0.15 (95% CI: €0.06–€0.27) billion, respectively. Conclusions: Italy is one of the European countries with the highest number of people with chronic HCV infection, the leading cause of cirrhosis, HCC and liver-related death. HCV-induced diseases cause a significant cost for Italian NHS, especially for each case of liver transplantation. These highly debilitating and life-threatening complications generate a rather large amount of indirect costs for the Italian society as well.