Costs Of Adverse Events Associated With Treatment Of Hepatitis C Virus Infection: An Analysis Using The Quebec Provincial Drug Reimbursement Program Database


      The objective was to estimate, in a real-life setting, 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.


      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 at the pharmacy for an HCV medication (pegylated interferon and ribavirin (peg-Riba) +/- boceprevir or telaprevir) from 2007 to 2013. 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.


      A total of 962 patients who used at least one HCV medication were included in the study (mean age: 47.9 years (SD=10.7), 61.5% males). The proportion of patients who used Peg-Riba only, Peg-Riba + boceprevir and Peg-Riba + telaprevir was 90.5%, 8.2% and 3.4% and treatment duration was 31.5 weeks, 30.4 weeks and 21.6 weeks respectively. During HCV treatment, the average number of health care resources used per patient was 13.2 physician’s visits and procedures, 0.8 hospitalization day and 0.8 emergency visit. While receiving HCV treatment, 20.8% of patients required erythropoietin, 33.3% received rash treatments and 48.8% were treated for depression. Estimated costs associated with management of these three AE were CDN$11,199, CDN$85 and CDN$282 per patient respectively, for a total of CDN$2,399,258 for this cohort.


      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.