Cost Associated with Adverse Events and Health Care Resources Utilization in Hepatitis C Virus Infection in Quebec, Canada


      The purpose of this study was to estimate the health care resource utilization, more specifically resource utilization for management of the most common adverse events (AE) associated with current treatment of hepatitis C virus (HCV) infection, in a real life setting.


      A retrospective study of the Quebec provincial drug reimbursement program (RAMQ) was conducted using a random sample of patients who filed at least one script for an HCV medication (pegylated-interferon and ribavirin (Peg-Riba) +/-boceprevir or telaprevir) between January 2007 and December 2012. Data on medical (excluding nurse visits) and pharmaceutical services were extracted from the RAMQ database. We report health care resources used during HCV treatment including outpatient physician’s visits and procedures, emergency visits, hospitalization days and costs associated with adverse events, which included medical services and medications.


      The study included 1,081 patients who used at least one HCV medication (mean age of 46.4 years [SD=10.7], 64.8% men). Peg-Riba only, Peg-Riba+boceprevir and Peg-Riba+telaprevir was used by 1,029 (95.2%), 50 (4.6%) and 18 (1.7%) patients respectively. Fifty-seven patients (5.3%) required a subsequent HCV treatment during the study period. The mean duration of treatments was 30.4 weeks (SD=16.1). During HCV treatment, the average number of health care resources per patient was 13.2 physician’s visits and procedures, 1.0 hospitalization day and 0.9 emergency visit. While receiving HCV treatment, 191 (17.7%) of patients required erythropoietin, 353 (32.7%) received rash treatments and 541 (50.0%) were treated for depression. Estimated costs associated with management of these three AE were CDN$10,834, CDN$78 and CDN$268 per patient respectively.


      HCV treatment is associated with significant health care resource utilization. A high proportion of patients experienced AE for which management was associated with substantial additional costs, especially the anemia treatment. Thus, the cost of AE should be considered in future treatment options.