1
|
Erman A, Sahakyan Y, Everett K, Greenaway C, Janjua N, Kwong JC, Wong WWL, Lu H, Sander B. Hepatitis C Attributable Healthcare Costs and Mortality among Immigrants: A Population-Based Matched Cohort Study. Can J Gastroenterol Hepatol 2024; 2024:5573068. [PMID: 38434933 PMCID: PMC10908570 DOI: 10.1155/2024/5573068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024] Open
Abstract
Background Data on the economic burden of chronic hepatitis C (CHC) among immigrants are limited. Our objective was to estimate the CHC-attributable mortality and healthcare costs among immigrants in Ontario, Canada. Methods We conducted a population-based matched cohort study among immigrants diagnosed with CHC between May 31, 2003, and December 31, 2018, using linked health administrative data. Immigrants with CHC (exposed) were matched 1 : 1 to immigrants without CHC (unexposed) using a combination of hard (index date, sex, and age) and propensity-score matching. Net costs (2020 Canadian dollars) collected from the healthcare payer perspective were calculated using a phase-of-care approach and used to estimate long-term costs adjusted for survival. Results We matched 5,575 exposed individuals with unexposed controls, achieving a balanced match. The mean age was 47 years, and 52% was male. On average, 10.5% of exposed and 3.5% of unexposed individuals died 15 years postindex (relative risk = 2.9; 95% confidence interval (CI): 2.6-3.5). The net 30-day costs per person were $88 (95% CI: 55 to 122) for the prediagnosis, $324 (95% CI: 291 to 356) for the initial phase, $1,016 (95% CI: 900 to 1,132) for the late phase, and $975 (95% CI: -25 to 1,974) for the terminal phase. The mean net healthcare cost adjusted for survival at 15 years was $90,448. Conclusions Compared to unexposed immigrants, immigrants infected with CHC have higher mortality rates and greater healthcare costs. These findings will support the planning of HCV elimination efforts among key risk groups in the province.
Collapse
Affiliation(s)
- Aysegul Erman
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Yeva Sahakyan
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
| | - Karl Everett
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Naveed Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jeffrey C. Kwong
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | | | - Hong Lu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| |
Collapse
|
2
|
Lee DU, Ponder R, Lee KJ, Yoo A, Fan GH, Jung D, Chou H, Lee K, Hofheinz O, Urrunaga NH. The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019. Eur J Gastroenterol Hepatol 2023; 35:402-419. [PMID: 36728850 PMCID: PMC9974787 DOI: 10.1097/meg.0000000000002498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) is a prominent liver disease that often presents with mental illness. We stratify the HCV population and review its healthcare burden on the US hospital system. METHODS The US National Inpatient Sample was used to select admissions related to HCV between 2016 and 2019. Weights were assigned to discharges, and trend analyses were performed. Strata were formed across demographics, comorbidities, psychiatric and substance use conditions, and other variables. Outcomes of interest included hospitalization incidences, mortality rates, total costs, and mean per-hospitalization costs. RESULTS From 2016 to 2019, there were improvements in mortality and hospitalization incidence for HCV, as well as a decline in aggregate costs across the majority of strata. Exceptions that showed cost growth included admissions with multiple psychiatric, stimulant use, or poly-substance use disorders, and a history of homelessness. Admissions with no psychiatric comorbidities, admissions with no substance use comorbidities, and admissions with housing and without HIV comorbidity showed decreasing total costs. Along with per-capita mean costs, admissions with comorbid opioid use, bipolar, or anxiety disorder showed significant increases. No significant trends in per-capita costs were found in admissions without mental illness diagnoses. CONCLUSIONS Most strata demonstrated decreases in hospitalization incidences and total costs surrounding HCV; however, HCV cases with mental illness diagnoses saw expenditure growth. Cost-saving mechanisms for these subgroups are warranted.
Collapse
Affiliation(s)
- David Uihwan Lee
- University of Maryland School of Medicine, Division of Gastroenterology and Hepatology, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Reid Ponder
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Ki Jung Lee
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Ashley Yoo
- University of Maryland School of Medicine, Division of Gastroenterology and Hepatology, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Gregory Hongyuan Fan
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Daniel Jung
- University of Missouri–Kansas City School of Medicine, Department of Medicine, 2411 Holmes St, Kansas City, MO 64108
| | - Harrison Chou
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Keeseok Lee
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Olivia Hofheinz
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Nathalie Helen Urrunaga
- University of Maryland School of Medicine, Division of Gastroenterology and Hepatology, 22 S. Greene St, Baltimore, MD 21201, USA
| |
Collapse
|
3
|
Ueda P, Pasternak B, Svanström H, Lim CE, Neovius M, Forssblad M, Ludvigsson JF, Kader M. Alcohol related disorders among elite male football players in Sweden: nationwide cohort study. BMJ 2022; 379:e074093. [PMID: 36543350 PMCID: PMC9768814 DOI: 10.1136/bmj-2022-074093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess whether male elite football players are at increased risk of alcohol related disorders compared with men from the general population, and whether such an increased risk would vary on the basis of calendar year of the first playing season in the top tier of competition, age, career length, and goal scoring abilities. DESIGN Nationwide cohort study. SETTING Sweden, 1924-2020. PARTICIPANTS 6007 male football players who had played in the Swedish top division, Allsvenskan, from 1924 to 2019 and 56 168 men from the general population matched to players based on age and region of residence. MAIN OUTCOME MEASURES Primary outcome was alcohol related disorders (diagnoses recorded in death certificates, during hospital admissions and outpatient visits, or use of prescription drugs for alcohol addiction); secondary outcome was disorders related to misuse of other drugs. RESULTS During follow-up up to 31 December 2020, 257 (4.3%) football players and 3528 (6.3%) men from the general population received diagnoses of alcohol related disorders. In analyses accounting for age, region of residence, and calendar time, risk of alcohol related disorders was lower among football players than among men from the general population (hazard ratio 0.71, 95% confidence interval 0.62 to 0.81). A reduced risk of alcohol related disorders was observed for football players who played their first season in the top tier in the early 1960s and later, while no significant difference versus men from the general population was seen in the risk for football players from earlier eras. The hazard ratio was lowest at around age 35 years, and then increased with age; at around age 75 years, football players had a higher risk of alcohol related disorders than men from the general population. No significant association was seen between goal scoring, number of games, and seasons played in the top tier and the risk of alcohol related disorders. Risk of disorders related to other drug misuse was significantly lower among football players than the general population (hazard ratio 0.22, 95% confidence interval 0.15 to 0.34). CONCLUSIONS In this nationwide cohort study, male football players who had played in the Swedish top tier of competition had a significantly lower risk of alcohol related disorders than men from the general population.
Collapse
Affiliation(s)
- Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Svanström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Carl-Emil Lim
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Ortopedi Stockholm, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - Manzur Kader
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Tsui TCO, Zeitouny S, Bremner KE, Cheung DC, Mulder C, Croxford R, Del Giudice L, Lapointe-Shaw L, Mendlowitz A, Wong WWL, Perlis N, Sander B, Teckle P, Tomlinson G, Walker JD, Malikov K, McGrail KM, Peacock S, Kulkarni GS, Pataky RE, Krahn MD. Initial health care costs for COVID-19 in British Columbia and Ontario, Canada: an interprovincial population-based cohort study. CMAJ Open 2022; 10:E818-E830. [PMID: 36126976 PMCID: PMC9497846 DOI: 10.9778/cmajo.20210328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COVID-19 imposed substantial health and economic burdens. Comprehensive population-based estimates of health care costs for COVID-19 are essential for planning and policy evaluation. We estimated publicly funded health care costs in 2 Canadian provinces during the pandemic's first wave. METHODS In this historical cohort study, we linked patients with their first positive SARS-CoV-2 test result by June 30, 2020, in 2 Canadian provinces (British Columbia and Ontario) to health care administrative databases and matched to negative or untested controls. We stratified patients by highest level of initial care: community, long-term care, hospital (without admission to the intensive care unit [ICU]) and ICU. Mean publicly funded health care costs for patients and controls, mean net (attributable to COVID-19) costs and total costs were estimated from 30 days before to 120 days after the index date, or to July 31, 2020, in 30-day periods for patients still being followed by the start of each period. RESULTS We identified 2465 matched people with a positive test result for SARS-CoV-2 in BC and 28 893 in Ontario. Mean age was 53.4 (standard deviation [SD] 21.8) years (BC) and 53.7 (SD 22.7) years (Ontario); 55.7% (BC) and 56.1% (Ontario) were female. Net costs in the first 30 days after the index date were $22 010 (95% confidence interval [CI] 19 512 to 24 509) and $15 750 (95% CI 15 354 to 16 147) for patients admitted to hospital, and $65 828 (95% CI 58 535 to 73 122) and $56 088 (95% CI 53 721 to 58 455) for ICU patients in BC and Ontario, respectively. In the community and long-term care settings, net costs were near 0. Total costs for all people, from 30 days before to 30 days after the index date, were $22 128 330 (BC) and $175 778 210 (Ontario). INTERPRETATION During the first wave, we found that mean costs attributable to COVID-19 were highest for patients with ICU admission and higher in BC than Ontario. Reducing the number of people who acquire COVID-19 and severity of illness are required to mitigate the economic impact of COVID-19.
Collapse
Affiliation(s)
- Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Seraphine Zeitouny
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Carol Mulder
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Ruth Croxford
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lisa Del Giudice
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lauren Lapointe-Shaw
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Nathan Perlis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Paulos Teckle
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Jennifer D Walker
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kamil Malikov
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kimberlyn M McGrail
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Stuart Peacock
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Girish S Kulkarni
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Reka E Pataky
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| |
Collapse
|
5
|
Nanwa N, Kwong JC, Feld JJ, Fangyun Wu C, Sander B. The mean attributable health care costs associated with hepatitis B virus in Ontario, Canada: A matched cohort study. CANADIAN LIVER JOURNAL 2022; 5:339-361. [DOI: 10.3138/canlivj-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: No Canadian studies examined the economic impact of hepatitis B virus (HBV) using population-based, patient-level data. We determined attributable costs associated with HBV from a health care payer perspective. METHODS: We conducted an incidence-based, matched cohort, cost-of-illness study. We identified infected subjects (positive HBV surface antigen, DNA, or e-antigen) between 2004 and 2014, using health administrative data. The index date was the first positive specimen. The cohort was organized into three groups: no HBV-related complications, HBV-related complications before index date, and HBV-related complications post-index date. To evaluate costs (2017 Canadian dollars), we adopted the phase-of-care approach defining six phases. Mean attributable costs were determined by evaluating mean differences between matched pairs. Hard match variables were sex, age group, index year, rurality, neighbourhood income quintile, comorbidities, and immigrant status. Costs were combined with crude survival data to calculate 1-, 5-, and 10-year costs. RESULTS: We identified 41,469 infected subjects with a mean age of 44.2 years. The majority were males (54.7%), immigrants (58.4%), and residents of major urban centres (96.8%). Eight percent had HBV-related complications before index date and 11.5% had them post index date. Across groups, mean attributable costs ranged from CAD-$27–$19 for pre-diagnosis, CAD$167–$1,062 for initial care, CAD$53–$407 for continuing care, CAD$1,033 for HBV-related complications, $304 for continuing care for complications, and CAD$2,552–$4,281 for final care. Mean cumulative 1-, 5-, and 10-year costs ranged between CAD$253–$3,067, $3,067–$20,349, and CAD$6,128–$38,968, respectively. CONCLUSIONS: HBV is associated with long-term economic burden. These results support decision-making on HBV prevention and monitoring strategies.
Collapse
Affiliation(s)
- Natasha Nanwa
- Public Health Ontario, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) collaborative, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- Toronto Western Family Health Team, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan J Feld
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease, Toronto, Ontario, Canada
- Sandra Rotman Centre for Global Health, Toronto General Research Institute, Toronto, Ontario, Canada
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) collaborative, Toronto, Ontario, Canada
- Population Health Economics Research (PHER), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Wong WWL, Wong J, Bremner KE, Saeed Y, Mason K, Phoon A, Feng Z, Feld JJ, Mitsakakis N, Powis J, Krahn M. Time Costs and Out-of-Pocket Costs in Patients With Chronic Hepatitis C in a Publicly Funded Health System. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:247-256. [PMID: 35094798 DOI: 10.1016/j.jval.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Chronic hepatitis C (CHC) infection affects more than 70 million people worldwide and imposes considerable health and economic burdens on patients and society. This study estimated 2 understudied components of the economic burden, patient out-of-pocket (OOP) costs and time costs, in patients with CHC in a tertiary hospital clinic setting and a community clinic setting. METHODS This was a multicenter, cross-sectional study with hospital-based (n = 174) and community-based (n = 101) cohorts. We used a standardized instrument to collect healthcare resource use, time, and OOP costs. OOP costs included patient-borne costs for medical services, nonprescription drugs, and nonmedical expenses related to healthcare visits. Patient and caregiver time costs were estimated using an hourly wage value derived from patient-reported employment income and, where missing, derived from the Canadian census. Sensitivity analysis explored alternative methods of valuing time. Costs were reported in 2020 Canadian dollars. RESULTS The mean 3-month OOP cost was $55 (95% confidence interval [CI] $21-$89) and $299 (95% CI $170-$427) for the community and hospital cohorts, respectively. The mean 3-month patient time cost was $743 (95% CI $485-$1002) (community) and $465 (95% CI $248-$682) (hospital). The mean 3-month caregiver time cost was $31 (95% CI $0-$63) (community) and $277 (95% CI $174-$380) (hospital). Patients with decompensated cirrhosis bore the highest costs. CONCLUSIONS OOP costs and patient and caregiver time costs represent a considerable economic burden to patient with CHC, equivalent to 14% and 21% of the reported total 3-month income for the hospital-based and community-based cohorts, respectively.
Collapse
Affiliation(s)
- William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Josephine Wong
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Yasmin Saeed
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kate Mason
- Toronto Community Hepatitis C Program, Toronto, Ontario, Canada
| | - Arcturus Phoon
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Mendlowitz A, Bremner KE, Walker JD, Wong WWL, Feld JJ, Sander B, Jones L, Isaranuwatchai W, Krahn M. Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study. CMAJ Open 2021; 9:E897-E906. [PMID: 34584004 PMCID: PMC8486469 DOI: 10.9778/cmajo.20200247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Colonization and marginalization have affected the risk for and experience of hepatitis C virus (HCV) infection for First Nations people in Canada. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we estimated the publicly borne health care costs associated with HCV infection among Status First Nations people in Ontario. METHODS In this retrospective matched cohort study, we used linked health administrative databases to identify Status First Nations people in Ontario who tested positive for HCV antibodies or RNA between 2004 and 2014, and Status First Nations people who had no HCV testing records or only a negative test result (control group, matched 2:1 to case participants). We estimated total and net costs (difference between case and control participants) for 4 phases of care: prediagnosis (6 mo before HCV infection diagnosis), initial (after diagnosis), late (liver disease) and terminal (6 mo before death), until death or Dec. 31, 2017, whichever occurred first. We stratified costs by sex and residence within or outside of First Nations communities. All costs were measured in 2018 Canadian dollars. RESULTS From 2004 to 2014, 2197 people were diagnosed with HCV infection. The mean net total costs per 30 days of HCV infection were $348 (95% confidence interval [CI] $277 to $427) for the prediagnosis phase, $377 (95% CI $288 to $470) for the initial phase, $1768 (95% CI $1153 to $2427) for the late phase and $893 (95% CI -$1114 to $3149) for the terminal phase. After diagnosis of HCV infection, net costs varied considerably among those who resided within compared to outside of First Nations communities. Net costs were higher for females than for males except in the terminal phase. INTERPRETATION The costs per 30 days of HCV infection among Status First Nations people in Ontario increased substantially with progression to advanced liver disease and finally to death. These estimates will allow for planning and evaluation of provincial and territorial population-specific hepatitis C control efforts.
Collapse
Affiliation(s)
- Andrew Mendlowitz
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont.
| | - Karen E Bremner
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jennifer D Walker
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jordan J Feld
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Lyndia Jones
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| |
Collapse
|
8
|
Tadrous M, Mason K, Dodd Z, Guyton M, Powis J, McCormack D, Gomes T. Prescribing trends in direct-acting antivirals for the treatment of hepatitis C in Ontario, Canada. CANADIAN LIVER JOURNAL 2021; 4:51-58. [PMID: 35991476 PMCID: PMC9203166 DOI: 10.3138/canlivj-2020-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/06/2020] [Indexed: 08/31/2024]
Abstract
Background Direct-acting antivirals (DAA) offer an opportunity to cure hepatitis C. Reimbursement for DAAs has changed on two occasions since their inclusion on the Ontario public formulary. Whether these changes have appreciably modified prescribing patterns and increased access to DAAs is unknown. Methods We conducted a repeated cross-sectional study of DAA reimbursement by the Ontario Public Drug Programs from January 1, 2012, to December 31, 2018, to summarize the use of DAAs in Ontario and describe changes in DAA prescribing physician specialties over this period. We measured the total number of users quarterly. Results are reported overall and by prescriber type. Results A total of 27,116 individuals received a publicly funded prescription for a DAA from the first quarter (Q1) of 2012 to the fourth quarter (Q4) of 2018. Nearly two-thirds (n = 17,813; 65.7%) of all DAAs were prescribed by gastroenterologists, hepatologists, or infectious disease specialists. Use of DAAs over time appears to have had three major phases in uptake: (1) the introduction of DAA treatments on the Ontario public drug formulary as a prior authorization benefit in Q1 2015, (2) expanded listing of all DAAs as limited-use products on the formulary in Q1 2017, and (3) the introduction of newer DAAs in Q2 2018. Conclusions Changes in listing of these agents had a direct impact on the use of DAAs overall. Generally, broader listing expanded access but did not appear to shift utilization patterns to primary care prescribers. Further understanding of who is not receiving treatment is needed.
Collapse
Affiliation(s)
- Mina Tadrous
- Women’s College Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - Zoë Dodd
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | | | - Jeff Powis
- Sherbourne Health, Toronto, Ontario, Canada
| | | | - Tara Gomes
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Webb JA, Fabreau G, Spackman E, Vaughan S, McBrien K. The cost-effectiveness of schistosomiasis screening and treatment among recently resettled refugees to Canada: an economic evaluation. CMAJ Open 2021; 9:E125-E133. [PMID: 33622765 PMCID: PMC8034375 DOI: 10.9778/cmajo.20190057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Many refugees and asylum seekers from countries where schistosomiasis is endemic are infected with the Schistosoma parasite when they arrive in Canada. We assessed, from a systemic perspective, which of the following management strategies by health care providers is cost-effective: testing for schistosomiasis and treating if the individual is infected, treating presumptively or waiting for symptoms to emerge. METHODS We constructed a decision-tree model to examine the cost-effectiveness of 3 management strategies: watchful waiting, screening and treatment, and presumptive treatment. We obtained data for the model from the literature and other sources, to predict deaths and chronic complications caused by schistosomiasis, as well as costs and net monetary benefit. RESULTS Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.1%. In our baseline analysis, presumptive treatment was associated with an increase of 0.156 quality-adjusted life years and a cost saving of $405 per person, compared with watchful waiting. It was also more effective and less costly than screening and treatment. INTERPRETATION Among recently resettled refugees and asylum claimants in Canada, from countries where schistosomiasis is endemic, presumptive treatment was predicted to be less costly and more effective than watchful waiting or screening and treatment. Our results support a revision of the current Canadian recommendations.
Collapse
Affiliation(s)
- John A Webb
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Gabriel Fabreau
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Eldon Spackman
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Kerry McBrien
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| |
Collapse
|
10
|
Wong WWL, Haines A, Bremner KE, Yao Z, Calzavara A, Mitsakakis N, Kwong JC, Sander B, Thein HH, Krahn MD. Health care costs associated with chronic hepatitis C virus infection in Ontario, Canada: a retrospective cohort study. CMAJ Open 2021; 9:E167-E174. [PMID: 33688024 PMCID: PMC8034296 DOI: 10.9778/cmajo.20200162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-quality estimates of health care costs are required to understand the burden of illness and to inform economic models. We estimated the costs associated with hepatitis C virus (HCV) infection from the public payer perspective in Ontario, Canada. METHODS In this population-based retrospective cohort study, we identified patients aged 18-105 years diagnosed with chronic HCV infection in Ontario from 2003 to 2014 using linked administrative data. We allocated the time from diagnosis until death or the end of follow-up (Dec. 31, 2016) to 9 mutually exclusive health states using validated algorithms: no cirrhosis, no cirrhosis (RNA negative) (i.e., cured HCV infection), compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, both decompensated cirrhosis and hepatocellular carcinoma, liver transplantation, terminal (liver-related) and terminal (non-liver-related). We estimated direct medical costs (in 2018 Canadian dollars) per 30 days per health state and used regression models to identify predictors of the costs. RESULTS We identified 48 239 patients with chronic hepatitis C, of whom 30 763 (63.8%) were men and 35 891 (74.4%) were aged 30-59 years at diagnosis. The mean 30-day costs were $798 (95% confidence interval [CI] $780-$816) (n = 43 568) for no cirrhosis, $661 (95% CI $630-$692) (n = 6422) for no cirrhosis (RNA negative), $1487 (95% CI $1375-$1599) (n = 4970) for compensated cirrhosis, $3659 (95% CI $3279-$4039) (n = 3151) for decompensated cirrhosis, $4238 (95% CI $3480-$4996) (n = 550) for hepatocellular carcinoma, $8753 (95% CI $7130-$10 377) (n = 485) for both decompensated cirrhosis and hepatocellular carcinoma, $4539 (95% CI $3746-$5333) (n = 372) for liver transplantation, $11 202 (95% CI $10 645-$11 760) (n = 3201) for terminal (liver-related) and $8801 (95% CI $8331-$9271) (n = 5278) for terminal (non-liver-related) health states. Comorbidity was the most significant predictor of total costs for all health states. INTERPRETATION Our findings suggest that the financial burden of HCV infection is substantially higher than previously estimated in Canada. Our comprehensive, up-to-date cost estimates for clinically defined health states of HCV infection should be useful for future economic evaluations related to this disorder.
Collapse
Affiliation(s)
- William W L Wong
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont.
| | - Alex Haines
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Karen E Bremner
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Zhan Yao
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Andrew Calzavara
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Nicholas Mitsakakis
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Jeffrey C Kwong
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Beate Sander
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Hla-Hla Thein
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| | - Murray D Krahn
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (Wong, Haines, Bremner, Sander, Thein, Krahn), University Health Network; ICES Central (Wong, Yao, Calzavara, Kwong, Sander); Dalla Lana School of Public Health (Mitsakakis, Kwong, Sander, Thein) and Department of Family and Community Medicine (Kwong), University of Toronto; Public Health Ontario (Kwong, Sander), Toronto, Ont
| |
Collapse
|
11
|
Mattingly TJ, Love BL, Khokhar B. Real World Cost-of-Illness Evidence in Hepatitis C Virus: A systematic review. PHARMACOECONOMICS 2020; 38:927-939. [PMID: 32533524 DOI: 10.1007/s40273-020-00933-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The introduction of direct-acting antivirals (DAAs) represents a potential clinical cure for hepatitis C virus (HCV) infection. Identification of costs associated with different stages of untreated disease through cost-of-illness (COI) evaluation helps inform policy decisions and cost-effectiveness analyses (CEAs). This study's objective was to review published real-world costs for patients with HCV to estimate the COI across different stages of disease progression. METHODS A literature search of EMBASE, Scopus, and PubMed from January 1, 2010 to August 31, 2019 was conducted to identify real-world evidence related to HCV. Data extraction included citation details, population, study type, costing method used, currency and inflation adjustments, and disease-specific costs. Standardized costing method categories (sum all medical, sum diagnosis specific, matching, regression, other incremental, and other total) were assigned. The risk of bias was assessed at the outcome level for influence on costs attributable to HCV. RESULTS The search strategy identified 278 studies, with 31 included in the final review after inclusion and exclusion criteria were applied. Retrospective cohorts (77%) and cross-sectional analyses (16%) were most frequently encountered. Sum Diagnosis Specific was the most common costing method (39%), followed by Regression (32%). Of the 31 studies analyzed, 35% included costs that would be included in a societal model. Costs were identified for various stages and complications related to HCV disease progression. Several studies included were determined to have a high (48%) or moderate risk (42%) of bias related to COI estimates. CONCLUSION Cost estimates for formal, informal, and non-health care services were identified in this review, but several challenges still exist in fully quantifying HCV burden. Future modeling studies including cost inputs should critically evaluate the risk of bias based on costing methods and data sources.
Collapse
Affiliation(s)
- T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
| | - Bryan L Love
- Department of Clinical Pharmacy and Outcomes Sciences, Center for Outcomes Research and Evaluation, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Bilal Khokhar
- General Dynamics Information Technology, Silver Spring, MD, USA
| |
Collapse
|
12
|
Mendlowitz AB, Naimark D, Wong WWL, Capraru C, Feld JJ, Isaranuwatchai W, Krahn M. The emergency department as a setting-specific opportunity for population-based hepatitis C screening: An economic evaluation. Liver Int 2020; 40:1282-1291. [PMID: 32267604 DOI: 10.1111/liv.14458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. METHODS We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. RESULTS For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY. CONCLUSIONS ED screening may represent a cost-effective component of population-based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.
Collapse
Affiliation(s)
- Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Naimark
- Department of Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,University Health Network - Toronto General Hospital, Toronto, ON, Canada
| |
Collapse
|
13
|
Shing E, Wang J, Nelder MP, Parpia C, Gubbay JB, Loeb M, Kristjanson E, Marchand-Austin A, Moore S, Russell C, Sider D, Sander B. The direct healthcare costs attributable to West Nile virus illness in Ontario, Canada: a population-based cohort study using laboratory and health administrative data. BMC Infect Dis 2019; 19:1059. [PMID: 31847823 PMCID: PMC6918579 DOI: 10.1186/s12879-019-4596-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/24/2019] [Indexed: 11/27/2022] Open
Abstract
Background West Nile virus (WNV) is a mosquito-borne flavivirus, first detected in the Western Hemisphere in 1999 and spread across North America over the next decade. Though endemic in the most populous areas of North America, few studies have estimated the healthcare costs associated with WNV. The objective of this study was to determine direct healthcare costs attributable to WNV illness in Ontario, Canada. Methods We conducted a cost-of-illness study on incident laboratory confirmed and probable WNV infected subjects identified from the provincial laboratory database from Jan 1, 2002 through Dec 31, 2012. Infected subjects were linked to health administrative data and matched to uninfected subjects. We used phase-of-care methods to calculate costs for 3 phases of illness: acute infection, continuing care, and final care prior to death. Mean 10-day attributable costs were reported in 2014 Canadian dollars, per capita. Sensitivity analysis was conducted to test the impact of WNV neurologic syndromes on healthcare costs. Results One thousand five hundred fifty-one laboratory confirmed and probable WNV infected subjects were ascertained; 1540 (99.3%) were matched to uninfected subjects. Mean age of WNV infected subjects was 49.1 ± 18.4 years, 50.5% were female. Mean costs attributable to WNV were $1177 (95% CI: $1001, $1352) for acute infection, $180 (95% CI: $122, $238) for continuing care, $11,614 (95% CI: $5916, $17,313) for final care - acute death, and $3199 (95% CI: $1770, $4627) for final care - late death. Expected 1-year costs were $13,648, adjusted for survival. Three hundred seventeen infected subjects were diagnosed with at least one neurologic syndrome and greatest healthcare costs in acute infection were associated with encephalitis ($4710, 95% CI: $3770, $5650). Conclusions WNV is associated with increased healthcare resource utilization across all phases of care. High-quality studies are needed to understand the health system impact of vector-borne diseases and evaluate the cost effectiveness of novel WNV interventions.
Collapse
Affiliation(s)
- Emily Shing
- Public Health Ontario, Toronto, Ontario, Canada.
| | - John Wang
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | | | - Mark Loeb
- Department of Pathology and Molecular Medicine; Department of Health Research, Evidence, and Impact; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Doug Sider
- Public Health Ontario, Toronto, Ontario, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Krahn MD, Bremner KE, de Oliveira C, Dixon SN, McFarlane P, Garg AX, Mitsakakis N, Blake PG, Harvey R, Pechlivanoglou P. Home Dialysis Is Associated with Lower Costs and Better Survival than Other Modalities: A Population-Based Study in Ontario, Canada. Perit Dial Int 2019; 39:553-561. [PMID: 31582466 DOI: 10.3747/pdi.2018.00268] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background:How and where to initiate dialysis are policy challenges with enormous economic and health consequences. Initiating with home hemodialysis (HD) or peritoneal dialysis (PD) may reduce costs and improve outcomes but evidence is conflicting.Methods:We conducted a population-based study in patients aged ≥ 18 years who initiated chronic dialysis in the province of Ontario, Canada from 2006 to 2014 (N = 12,691) using linked administrative data. Patients were grouped by initial modality: facility HD, facility short daily or slow nocturnal (SD/SN) HD, PD, home HD. We estimated publicly-paid healthcare costs (2015 Canadian dollars; 1 = 0.947 US dollar) and survival, from dialysis initiation to March 2015.Results:By 5 years after dialysis initiation, mean 30-day costs (as-treated) for patients receiving PD and home HD were 50% and 64% lower, respectively, than for facility HD patients ($11,011). Approximately 50% of costs were unrelated to dialysis, reflecting high comorbidity in these patients. With covariate adjustment, mean 5-year cumulative costs were similar for initiators of home HD and PD ($304,178 and $349,338) and higher for facility HD initiators ($410,981). The highest 5-year unadjusted survival was for home HD patients (80%), followed by PD (52%), SD/SN HD (50%), and facility HD (42%).Conclusions:This study in a large cohort over 9 years provides new population-based evidence suggesting that initiating dialysis at home is cost-effective, with lower costs and better survival, than starting with facility HD. Survival differences persisted after adjustment for baseline characteristics but we could not adjust for functional status or severity of comorbidities.
Collapse
Affiliation(s)
- Murray D Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Claire de Oliveira
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephanie N Dixon
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Division of Nephrology, London Health Sciences Centre, Victoria Hospital and University Hospital, London, ON, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter G Blake
- Ontario Renal Network, Toronto, ON, Canada.,Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | | |
Collapse
|
15
|
Makarenko I, Artenie A, Hoj S, Minoyan N, Jacka B, Zang G, Barlett G, Jutras-Aswad D, Martel-Laferriere V, Bruneau J. Transitioning from interferon-based to direct antiviral treatment options: A potential shift in barriers and facilitators of treatment initiation among people who use drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:69-76. [PMID: 31010749 DOI: 10.1016/j.drugpo.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/31/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple barriers for accessing hepatitis C virus (HCV) treatment were identified during the interferon-based (IFN) treatment era for people who inject drugs (PWID). Whether these barriers persist since the introduction of IFN-free direct-acting antiviral (DAA) agents in Canada remains to be documented. This study examined temporal trends in HCV treatment initiation and associated factors during the transition from INF-based to all-oral DAA regimens. METHODS The study population was drawn from a prospective cohort of PWID in Montreal, Canada. At three-month/one-year intervals between 2011 and 2017, participants with chronic HCV infection completed an interviewer-administered questionnaire on socio-demographic characteristics, drug use and health service utilisation, including HCV treatment. Time-updated Cox multivariate regression models, stratified by DAA + INF (2011-2013) and all-oral DAA (2014-2017) availability periods, were conducted to examine associations between time to HCV treatment initiation and associated barriers and facilitators. RESULTS Of 308 participants (85% male, median age 42 [IQR: 33, 50]), 80 (26%) initiated HCV treatment during 915 person-years (PY). Incidence rates increased from 1.6 /100 PY (95%CI:0.9-2.6) in 2011 to 12.7 (10.6-15.1) in 2017 (p-trend = 0.0012). In multivariate analyses, visiting a primary care physician (2011-2013: aHR = 3.63[1.21-10.9]; 2014-2017: 2.52[1.10-5.77]) and frequent injection (0.23[0.05-0.99] and 0.49[0.24-0.99]) were consistently associated with treatment initiation. Participants aged >40 (2.27[1.24-4.13]), receiving opioid agonist therapy (OAT) (2.17[1.19-3.94]), and reporting prior HCV treatment (3.00[1.75-5.15]) were more likely to initiate treatment in the all-oral DAA period. CONCLUSION Treatment initiation increased between 2011 and 2017, but still remains low among PWID. Primary care visiting was a key facilitator regardless of the period, while engagement in OAT and health services, indicated by prior HCV treatment, increased the likelihood of treatment initiation in the DAA era. These findings suggest that access to health services is essential but not enough to scale up treatment in this population.
Collapse
Affiliation(s)
- Iuliia Makarenko
- McGill University, Department of Family Medicine, Montreal, QC, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Adelina Artenie
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stine Hoj
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Brendan Jacka
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Geng Zang
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gillian Barlett
- McGill University, Department of Family Medicine, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Valerie Martel-Laferriere
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Julie Bruneau
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
16
|
Shing E, Wang J, Khoo E, Evans GA, Moore S, Nelder MP, Patel SN, Russell C, Sider D, Sander B. Estimating direct healthcare costs attributable to laboratory-confirmed Lyme disease in Ontario, Canada: A population-based matched cohort study using health administrative data. Zoonoses Public Health 2019; 66:428-435. [PMID: 30665259 DOI: 10.1111/zph.12560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/29/2018] [Accepted: 12/15/2018] [Indexed: 12/28/2022]
Abstract
The objective of this study was to determine healthcare costs attributable to laboratory-confirmed Lyme disease (LD) from the healthcare payer perspective in Ontario, Canada. A cost-of-illness study was conducted for incident LD subjects from 1 January 2006 through 31 December 2013 ascertained from provincial laboratory and reportable disease databases, linked to health administrative data. All LD subjects included were laboratory-confirmed, according to provincial case definitions. Incident LD subjects were propensity-score matched to uninfected subjects on age, sex, comorbidities and urban/rural status. We used phase-of-care methods to calculate attributable costs for two phases of illness: initial care (≤30 days following "index date") and continuing care (>30 days after index date to the end of the follow-up period). A total of 663 incident, confirmed LD subjects were identified from 2006 through 2013. Mean age was 44.2 ± 20.1 years; 339 (51.1%) were female; and 31 (4.7%) were hospitalized ≤30 days after index date. Six hundred fifty-eight (99.2%) LD subjects were matched to uninfected subjects; mean follow-up time was 3.3 years. Mean attributable costs per case during the initial care phase and continuing care were $277 (95% CI: $197, $357) and -$5 (-$27, $17), respectively. Attributable costs per LD subject aged 5-14 years were $440 ($132, $747), greater than the costs observed for other age strata. Expected 1-year attributable costs were $832, given continuing care costs were negligible. Limitations to our study include estimating costs using a cohort of only laboratory-confirmed LD cases, introducing selection bias for diagnosed and treated patients who may have a lower risk of developing sequelae. In conclusion, the initial care phase of LD is associated with increased healthcare costs, but without significant costs attributable to LD infection after 30 days. Estimates of costs attributable to LD are important for healthcare resource prioritization and the evaluation of novel interventions.
Collapse
Affiliation(s)
- Emily Shing
- Public Health Ontario, Toronto, Ontario, Canada
| | - John Wang
- Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Edwin Khoo
- Public Health Ontario, Toronto, Ontario, Canada
| | - Gerald A Evans
- Public Health Ontario, Toronto, Ontario, Canada.,Queens University, Kingston, Ontario, Canada
| | | | | | - Samir N Patel
- Public Health Ontario, Toronto, Ontario, Canada.,Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | | | - Doug Sider
- Public Health Ontario, Toronto, Ontario, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Wong WWL, Haines A, Farhang Zangneh H, Shah H. Can we afford not to screen and treat hepatitis C virus infection in Canada? CANADIAN LIVER JOURNAL 2018; 1:51-65. [PMID: 35990719 PMCID: PMC9202796 DOI: 10.3138/canlivj.1.2.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 08/20/2023]
Abstract
BACKGROUND Screening for hepatitis C virus (HCV) followed by direct-acting antiviral (DAA) treatment in individuals born between 1945 and 1964 has been shown to be both effective and cost-effective, but the question of affordability remains unresolved. We looked at long-term cost and health outcomes of HCV screening for Ontario up to 2030. METHODS We used a validated state-transition model to analyze the budget and health impact of HCV screening followed by DAA treatment in individuals born between 1945 and 1964 versus current practice. We used a payer's perspective, discounting costs at an annual rate of 1.5%. Costs, liver-related deaths, and hepatocellular carcinoma (HCC) and decompensated cirrhosis (DC) cases detected were measured over a 14-year period. RESULTS By 2030, the cost of implementing a HCV screening program for individuals born between 1945 and 1964 will add an additional $845 million to the Ontario health care budget. Sensitivity analyses showed that DAA costs had the largest effect on the budget, and decreasing DAA costs to $16,000 will lead to a significantly lower budget impact of $331 million. Regarding population health, a screen-and-treat strategy will prevent 1,199 cases of HCC, 1,565 cases of DC, and 1,665 liver-related deaths by 2030. CONCLUSIONS Contrasting the budget impact of this HCV screening strategy with other recommended health services and technologies, we conclude that HCV screening should be considered affordable. If Canada is committed to meeting the targets set out by the World Health Organization, then provinces cannot afford to not expand current screening programs.
Collapse
Affiliation(s)
- William WL Wong
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Haines
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Hooman Farhang Zangneh
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hemant Shah
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Greenaway C, Makarenko I, Tanveer F, Janjua NZ. Addressing hepatitis C in the foreign-born population: A key to hepatitis C virus elimination in Canada. CANADIAN LIVER JOURNAL 2018; 1:34-50. [PMID: 35990716 PMCID: PMC9202799 DOI: 10.3138/canlivj.1.2.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 10/26/2023]
Abstract
Hepatitis C virus (HCV) is the leading cause of death from infectious disease in Canada. Immigrants are an important group who are at increased risk for HCV; they account for a disproportionate number of all HCV cases in Canada (~30%) and have approximately a twofold higher prevalence of HCV (~2%) than those born in Canada. HCV-infected immigrants are more likely to develop cirrhosis and hepatocellular carcinoma and are more likely to have a liver-related death during a hospitalization than HCV-infected non-immigrants. Several factors, including lack of routine HCV screening programs in Canada for immigrants before or after arrival, lack of awareness on the part of health practitioners that immigrants are at increased risk of HCV and could benefit from screening, and several patient- and health system-level barriers that affect access to health care and treatment likely contribute to delayed diagnosis and treatment uptake. HCV screening and engagement in care among immigrants can be improved through reminders in electronic medical records that prompt practitioners to screen for HCV during clinical visits and implementation of decentralized community-based screening strategies that address cultural and language barriers. In conclusion, early screening and linkage to care for immigrants from countries with an intermediate or high prevalence of HCV would not only improve the health of this population but will be key to achieving HCV elimination in Canada. This article describes the unique barriers encountered by the foreign-born population in accessing HCV care and approaches to overcoming these barriers.
Collapse
Affiliation(s)
- Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Iuliia Makarenko
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Fozia Tanveer
- CATIE (Canada’s source for HIV and hepatitis C information), Toronto, Ontario, Canada
| | - Naveed Z Janjua
- Clinical Preventative Services, British Columbia Centers for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
19
|
Mitchell S, Bungay V, Day CA, Mooney-Somers J. Has the Experience of Hepatitis C Diagnosis Improved Over the Last Decade? An Analysis of Canadian Women's Experiences. Can J Nurs Res 2018; 48:21-28. [PMID: 28841069 DOI: 10.1177/0844562116665477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Canada, incidents of new hepatitis C virus infections are rising among women aged 15-29 years and now comprise 60% of new infections among this age group. A negative diagnosis experience continues to be a problem affecting women living with hepatitis C virus. With new effective treatments, nurses will have more involvement in hepatitis C virus care and diagnosis, which is a critical time to facilitate appropriate education and management. Purpose This study explored Canadian women's experience of hepatitis C virus diagnosis in order to develop recommendations to improve care at the point of diagnosis. Methods Purposive sampling was used to recruit and interview 25 women. Using narrative inquiry, we examined Canadian women's experience of hepatitis C virus diagnosis. Results Women's diagnosis experiences were shaped by the context of diagnosis, factors prompting the testing, the testing provider, and information/education received. The context of diagnosis foreshadowed how prepared women were for their results, and the absence of accurate information magnified the psychological distress that can follow an hepatitis C virus diagnosis. Conclusion Our findings provide a compelling case for a proactive nursing response, which will improve women's experiences of hepatitis C virus diagnosis and, in turn, enhance women's access to hepatitis C virus care and other healthcare services.
Collapse
Affiliation(s)
- Sandi Mitchell
- 1 School of Public Health, University of Sydney, Australia
| | - Vicky Bungay
- 2 Michael Smith Foundation for Health Research Scholar, School of Nursing, University of British Columbia, Canada
| | - Carolyn A Day
- 3 Discipline of Addiction Medicine, Central Clinical School (C39), University of Sydney, Australia
| | - Julie Mooney-Somers
- 4 Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Australia
| |
Collapse
|
20
|
Souliotis K, Siakavellas S, Golna C, Manesis E, Papatheodoridis G, Hatzakis A. Real-life cost of managing chronic HCV infection in Greece prior to Direct-Acting Antivirals (DAAs): an undeniable truth of spending more for less. Hippokratia 2018; 22:127-131. [PMID: 31641333 PMCID: PMC6801118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Chronic hepatitis C virus (HCV) infection is a major public health challenge across the world. Before the introduction of Direct-Acting Antivirals (DAAs), managing and treating the disease and its possible complications (cirrhosis, hepatocellular carcinoma) placed a considerable financial burden on public health resources. This study estimates the financial burden of managing HCV in Greece before the introduction of DAAs. PATIENTS AND METHODS We reviewed the clinical records of 146 consecutive patients with chronic HCV that were regularly followed-up at two tertiary hospitals in Athens. Public health resources utilization was recorded by category for consultations, hospitalizations, medications [for the pre-DAAs: pegylated interferon (PEG-IFN) and ribavirin (RBV) regimens), and laboratory and imaging tests. Overall disease burden was stratified according to fibrosis stage in four categories [F1-F2, F3-F4, decompensated cirrhosis, and hepatocellular carcinoma (HCC) - liver transplantation (LT)]. All cost calculations were based on current prices in the Greek Public Health System. RESULTS The average cost per patient on treatment was €8,629 for F1-F2 patients, €13,302 for F3-F4 patients, €14,678 for patients with decompensated cirrhosis, and €48,152 for patients with HCC or LT. Main cost drivers were medications (75.6 % of total cost), laboratory and imaging tests (12.4 %) and hospitalizations (11.4 %). Hospitalization cost grew significantly as the disease progressed. CONCLUSIONS Chronic hepatitis C places a substantial economic burden on the Greek Public Health System. This burden is expected to increase exponentially as patients move to more advanced disease stages. Robust interventions to deter chronic HCV infection progression should be considered beneficial from a long-term economic perspective. HIPPOKRATIA 2018, 22(3): 127-131.
Collapse
Affiliation(s)
- K Souliotis
- Department of Social and Educational Policy, Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
- Health Policy Institute, Laiko General Hospital, Athens, Greece
| | - S Siakavellas
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - C Golna
- Innowth Ltd, Larnaca, Cyprus
| | - E Manesis
- Division of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
21
|
Janjua NZ, Islam N, Wong J, Yoshida EM, Ramji A, Samji H, Butt ZA, Chong M, Cook D, Alvarez M, Darvishian M, Tyndall M, Krajden M. Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study. J Viral Hepat 2017; 24:624-630. [PMID: 28130810 DOI: 10.1111/jvh.12684] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/22/2016] [Indexed: 12/15/2022]
Abstract
We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.
Collapse
Affiliation(s)
- N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - N Islam
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Z A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - D Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Darvishian
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
22
|
Janjua NZ, Chong M, Kuo M, Woods R, Wong J, Yoshida EM, Sherman M, Butt ZA, Samji H, Cook D, Yu A, Alvarez M, Tyndall M, Krajden M. Long-term effect of sustained virological response on hepatocellular carcinoma in patients with hepatitis C in Canada. J Hepatol 2017; 66:504-513. [PMID: 27818234 DOI: 10.1016/j.jhep.2016.10.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/19/2016] [Accepted: 10/22/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Evidence is limited on hepatocellular carcinoma (HCC) risk after sustained virological response (SVR) to interferon-based treatment of hepatitis C virus (HCV) infection. We evaluated the effect of SVR on the risk of HCC and estimated its incidence in post-SVR HCV patients from a large population-based Canadian cohort. METHODS The British Columbia Hepatitis Testers Cohort includes individuals tested for HCV between 1990-2013 linked with data on their medical visits, hospitalizations, cancers, prescription drugs and mortality. Patients receiving interferon-based HCV treatments were followed from the end of treatment to HCC diagnosis, death or December 31, 2012. We examined HCC risk among those who did and did not achieve SVR using multivariable proportional hazard models with the Fine and Gray modification for competing risks. RESULTS Of 8147 individuals who received HCV treatment and were eligible for analysis, 4663 (57%) achieved SVR and 3484 (43%) did not. Each group was followed for a median of 5.6years (range: 0.5-12.9) for an HCC incidence rate of 1.1/1000 person-years (PY) among the SVR and 7.2/1000 PY among the no SVR group. The HCC incidence rate was higher among those with cirrhosis (SVR: 6.4, no SVR: 21.0/1000 PY). In the multivariable model, SVR was associated with a lower HCC risk (subdistribution hazard ratio [SHR]=0.20, 95% CI: 0.13-0.3), while cirrhosis (SHR=2.61, 95% CI: 1.68-4.04), age ⩾50years, being male and genotype 3 infection were associated with a higher HCC risk. Among those who achieved SVR, cirrhosis, age ⩾50years and being male were associated with a higher HCC risk. CONCLUSION SVR after interferon-based treatment substantially reduces but does not eliminate HCC risk, which is markedly higher among those with cirrhosis and age ⩾50years at treatment initiation. Treatment of patients at an advanced fibrosis stage with new highly effective drugs will warrant continued surveillance for HCC post-SVR. LAY SUMMARY We assessed the effect of successful hepatitis C treatment with older interferon-based treatment on the occurrence of liver cancer (hepatocellular carcinoma) and found that successful treatment prevents liver cancer. However, more people with cirrhosis and older age continued to develop liver cancer after successful treatment. Thus, treatment with new drugs among those with cirrhosis will require continued monitoring for liver cancer.
Collapse
Affiliation(s)
- Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Margot Kuo
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ryan Woods
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Morris Sherman
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
23
|
Wong WWL, Lee KM, Singh S, Wells G, Feld JJ, Krahn M. Drug therapies for chronic hepatitis C infection: a cost-effectiveness analysis. CMAJ Open 2017; 5:E97-E108. [PMID: 28401125 PMCID: PMC5378540 DOI: 10.9778/cmajo.20160161] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Before 2011, pegylated interferon plus ribavirin was the standard therapy for chronic hepatitis C. Interferon-free direct-acting antiviral agents were then approved. Although these treatments appear to be more effective, they are substantially more expensive. In anticipation of the need for information regarding the comparative cost-effectiveness of new regimens in a recent therapeutic review, we conducted the analysis to inform listing decision in Canada. METHODS A state-transition model was developed in the form of a cost-utility analysis. Regimens included in the analysis were comprehensive. The cohort under consideration had a mean age of 50 years. The cohort was defined by treatment status and cirrhosis status. Inputs for the model were derived from published sources and validated by clinical experts. RESULTS For each genotype 1 population, at least 1 of the interferon-free agents appeared to be economically attractive compared with pegylated interferon-ribavirin, at a willingness-to-pay of $50 000 per quality-adjusted life-year. The drug that was the most cost-effective varied by population. For genotype 2-4 population, the direct-acting antiviral therapies appeared not to be economically attractive compared with pegylated interferon-ribavirin for the treatment-naive; however, there were direct-acting antiviral therapies that appeared to be attractive when compared with no treatment for the treatment-experienced. INTERPRETATION Public health policy should be informed by consideration of health benefit, social and ethical values, feasibility and cost-effectiveness. Our analysis assists the development of reimbursements and policies for interferon-free direct-acting antiviral agent regimens for chronic hepatitis C infection by informing the last criterion. Considering the rapid development of treatments for chronic hepatitis C, further update and expanded reviews will be necessary.
Collapse
Affiliation(s)
- William W L Wong
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont
| | - Karen M Lee
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont
| | - Sumeet Singh
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont
| | - George Wells
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont
| | - Jordan J Feld
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont
| | - Murray Krahn
- School of Pharmacy (Wong), University of Waterloo, Kitchener, Ont.; Toronto Health Economics and Technology Assessment Collaborative (THETA) (Wong, Krahn), Faculty of Pharmacy, University of Toronto, Toronto, Ont.; Canadian Agency for Drugs and Technologies in Health (CADTH) (Lee, Singh), Ottawa, Ont.; School of Epidemiology, Public Health and Preventative Medicine (Lee), University of Ottawa, Ottawa, Ont.; Cardiovascular Research Methods Centre (Wells), University of Ottawa Heart Institute, Ottawa, Ont.; Toronto Centre for Liver Disease (Feld), University Health Network, University of Toronto, Toronto, Ont
| |
Collapse
|
24
|
The Economic Burden of Hospital-Acquired Clostridium difficile Infection: A Population-Based Matched Cohort Study. Infect Control Hosp Epidemiol 2016; 37:1068-78. [PMID: 27322606 DOI: 10.1017/ice.2016.122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND High-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making. OBJECTIVE To evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective. METHODS We conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars. RESULTS We identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0-107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192-$36,005), $34,843 ($29,298-$40,027), and $37,171 ($30,364-$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221-$22,609), $26,074 ($25,180-$27,014), and $29,944 ($28,873-$31,086), respectively. CONCLUSIONS Hospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease. Infect Control Hosp Epidemiol 2016;37:1068-1078.
Collapse
|
25
|
Sánchez-González G. The cost-effectiveness of treating triple coinfection with HIV, tuberculosis and hepatitis C virus. HIV Med 2016; 17:674-82. [PMID: 27279355 DOI: 10.1111/hiv.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the cost-effectiveness of treating patients infected with HIV and simultaneously coinfected with tuberculosis (TB) and hepatitis C virus (HCV). METHODS A mathematical model for HIV coinfection with TB and HCV is introduced. The model was designed to incorporate parameters of control for the coverage of care, which makes it useful for performing cost-effectiveness analysis of public policies. A cost-effectiveness analysis of early medical care of patients with TB and HCV coinfection, with coverage of 0 (basal), 25, 50, 75 and 100%, was performed for the whole cohort of patients and a special analysis was performed in a selected population with triple infection. RESULTS The cost per resolved infection and the cost per year of life gained were found to be very cost-effective for the population with triple infection, for all different coverages. CONCLUSIONS It is known that treating patients with HIV who are coinfected with TB or HCV implies high cost and low efficacy, but it is possible that the population with triple infections could achieve important benefits in terms of years of life gained.
Collapse
Affiliation(s)
- G Sánchez-González
- Immunology Division, National Institute of Public Health, Cuernavaca, Mexico
| |
Collapse
|
26
|
He T, Li K, Roberts MS, Spaulding AC, Ayer T, Grefenstette JJ, Chhatwal J. Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons. Ann Intern Med 2016; 164:84-92. [PMID: 26595252 PMCID: PMC4854298 DOI: 10.7326/m15-0617] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prevalence of hepatitis C virus (HCV) in U.S. prisoners is high; however, HCV testing and treatment are rare. Infected inmates released back into society contribute to the spread of HCV in the general population. Routine hepatitis screening of inmates followed by new therapies may reduce ongoing HCV transmission. OBJECTIVE To evaluate the health and economic effect of HCV screening and treatment in prisons on the HCV epidemic in society. DESIGN Agent-based microsimulation model of HCV transmission and progression of HCV disease. DATA SOURCES Published literature. TARGET POPULATION Population in U.S. prisons and general community. TIME HORIZON 30 years. PERSPECTIVE Societal. INTERVENTIONS Risk-based and universal opt-out hepatitis C screening in prisons, followed by treatment in a portion of patients. OUTCOME MEASURES Prevention of HCV transmission and associated disease in prisons and society, costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and total prison budget. RESULTS OF BASE-CASE ANALYSIS Implementing risk-based and opt-out screening could diagnose 41,900 to 122,700 new HCV cases in prisons in the next 30 years. Compared with no screening, these scenarios could prevent 5500 to 12,700 new HCV infections caused by released inmates, wherein about 90% of averted infections would have occurred outside of prisons. Screening could also prevent 4200 to 11,700 liver-related deaths. The ICERs of screening scenarios were $19,600 to $29,200 per QALY, and the respective first-year prison budget was $900 to $1150 million. Prisons would require an additional 12.4% of their current health care budget to implement such interventions. RESULTS OF SENSITIVITY ANALYSIS Results were sensitive to the time horizon, and ICERs otherwise remained less than $50,000 per QALY. LIMITATION Data on transmission network, reinfection rate, and opt-out HCV screening rate are lacking. CONCLUSION Universal opt-out HCV screening in prisons is highly cost-effective and would reduce HCV transmission and HCV-associated diseases primarily in the outside community. Investing in U.S. prisons to manage hepatitis C is a strategic approach to address the current epidemic. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
|
27
|
Moshyk A, Martel MJ, Tahami Monfared AA, Goeree R. Cost-effectiveness of daclatasvir plus sofosbuvir-based regimen for treatment of hepatitis C virus genotype 3 infection in Canada. J Med Econ 2016; 19:181-92. [PMID: 26453248 DOI: 10.3111/13696998.2015.1106546] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE New regimens for the treatment of chronic hepatitis C virus (HCV) genotype 3 have demonstrated substantial improvement in sustained virologic response (SVR) compared with existing therapies, but are considerably more expensive. The objective of this study was to evaluate the cost-effectiveness of two novel all-oral, interferon-free regimens for the treatment of patients with HCV genotype 3: daclatasvir plus sofosbuvir (DCV + SOF) and sofosbuvir plus ribavirin (SOF + RBV), from a Canadian health-system perspective. METHODS A decision analytic Markov model was developed to compare the effect of various treatment strategies on the natural history of the disease and their associated costs in treatment-naïve and treatment-experienced patients. Patients were initially distributed across fibrosis stages F0-F4, and may incur disease progression through fibrosis stages and on to end-stage liver disease complications and death; or may achieve SVR. Clinical efficacy, health-related quality-of-life, costs, and transition probabilities were based on published literature. Probabilistic sensitivity analysis was performed to assess parameter uncertainty associated with the analysis. RESULTS In treatment-naive patients, the expected quality-adjusted life years (QALYs) for interferon-free regimens were higher for DCV + SOF (12.37) and SOF + RBV (12.48) compared to that of pINF + RBV (11.71) over a lifetime horizon, applying their clinical trial treatment durations. The expected costs were higher for DCV + SOF ($170,371) and SOF + RBV ($194,776) vs pINF + RBV regimen ($90,905). Compared to pINF + RBV, the incremental cost-effectiveness ratios (ICER) were $120,671 and $135,398 per QALYs for DCV + SOF and SOF + RBV, respectively. In treatment-experienced patients, DCV + SOF regimen dominated the SOF + RBV regimen. Probabilistic sensitivity analysis indicated a 100% probability that a DCV + SOF regimen was cost saving in treatment-experienced patients. CONCLUSION Daclatasvir plus sofosbuvir is a safe and effective option for the treatment of chronic HCV genotype 3 patients. This regimen could be considered a cost-effective option following a first-line treatment of peg-interferon/ribavirin treatment experienced patients with HCV genotype-3 infection.
Collapse
Affiliation(s)
- A Moshyk
- a a BMS Canada, Market Access and Public Affairs , Saint-Laurent, Quebec , Canada
| | - M-J Martel
- a a BMS Canada, Market Access and Public Affairs , Saint-Laurent, Quebec , Canada
| | - A A Tahami Monfared
- a a BMS Canada, Market Access and Public Affairs , Saint-Laurent, Quebec , Canada
| | - R Goeree
- b b Goeree Consulting and Professor Emeritus, McMaster University , Hamilton , Ontario , Canada
| |
Collapse
|
28
|
Chen W, Krahn M. Disease burden of chronic hepatitis C among immigrants in Canada. J Viral Hepat 2015; 22:1043-54. [PMID: 26110922 DOI: 10.1111/jvh.12432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/30/2015] [Indexed: 01/16/2023]
Abstract
Immigrants with chronic hepatitis C (CHC) in Canada have doubled risk of hepatocellular carcinoma. To measure the burden of CHC among immigrants in Canada. A decision analytic model was developed to compare immigrants with CHC and age-matched immigrants without CHC for survival years, quality-adjusted life-years (QALYs) and medical costs per life year. Hepatitis C epidemiology among immigrants was based on hepatitis C prevalence in their home countries. A cohort of immigrant patients was retrospectively followed up to estimate fibrosis stage distribution, treatment patterns and prognosis of compensated cirrhosis. Other model variables were based on published sources. Base case analysis, one-way sensitivity analysis and probabilistic sensitivity analysis were performed to measure the burden of CHC and assess the impact of uncertainty associated with model variables on the burden of CHC. CHC could reduce survival by 9.6 years [95% credible interval (CI): 8.0-10.9 years], reduce QALYs by 9.5 years (95% CI: 6.0-13.8 years) and increase medical costs per life year by $1950 (95% CI: $1518 to $2486, 2006 Canadian dollars). Because nearly half of immigrants with CHC were not diagnosed until the development of cirrhosis, the burden of CHC was highly sensitive to the risks of liver-related complications and mortality but insensitive to pegylated interferon plus ribavirin. The burden of CHC among immigrants in Canada is substantial mainly due to liver-related complications and mortality. The delay in diagnosis was another important contributor to the burden of CHC among immigrants.
Collapse
Affiliation(s)
- W Chen
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.,Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - M Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.,Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
29
|
Kouyoumdjian FG, McIsaac KE. Persons in correctional facilities in Canada: A key population for hepatitis C prevention and control. Canadian Journal of Public Health 2015; 106:e454-6. [PMID: 26680439 DOI: 10.17269/cjph.106.5132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/14/2015] [Accepted: 07/19/2015] [Indexed: 12/28/2022]
Abstract
About one in nine Canadians who are infected with hepatitis C spend time in a correctional facility each year. With high rates of current injection drug use and needle sharing, this population may account for a large proportion of new infections. Any national strategy to address hepatitis C should include a focus on persons in correctional facilities, and should build on existing evidence regarding primary, secondary and tertiary prevention.
Collapse
|
30
|
Jozaghi E. Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection. HEALTH & JUSTICE 2015; 3:16. [PMCID: PMC5151785 DOI: 10.1186/s40352-015-0028-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/17/2015] [Indexed: 07/28/2023]
Abstract
Background Supervised consumption rooms or supervised injection facilities (SIFs) are venues that have reduced the risk of needle sharing and deaths caused by drug overdose among people who inject drugs (PWID). As a result of such a decline in the mortality rate, numerous studies have been able to illustrate its cost-effectiveness. However, studies have neglected to examine the same phenomena for unsanctioned SIFs that are run by peer drug users and provide assisted injections. Methods The current study will determine whether the former unsanctioned SIF, that provided assisted injection and was operated by the grass root organization called Vancouver Area Network of Drug Users (VANDU), cost less than the health care consequences of not having such a program in Vancouver, Canada. By analyzing data gathered in 2013, this paper relies on two mathematical models to estimate the number of new HIV and HCV infections prevented by the former unsanctioned facility in Vancouver’s Downtown Eastside. Results A conservative estimate indicates that the SIF location that provided assisted injections has a benefit-cost ratio of 33.1:1 due to its low operational cost. At the baseline sharing rate, the facility, on an average, reduced 81 HCV and 30 HIV cases among PWID each year. Such reductions in blood borne infections among PWID resulted in annual savings worth CAN$4.3 million dollars in health care expenditure. In addition to this, the current paper relies on a sensitivity analysis based on different needle sharing rate scenarios. Conclusions The sensitivity analysis and the baseline rates indicate that funding SIF facilities operated by peer drug users that facilitate assisted injection appear to be an efficient and effective use of financial resources in the public health domain since they lead to a significant decline in the rate of mortality within a vulnerable population.
Collapse
Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, British Columbia Canada
| | | |
Collapse
|
31
|
Yeung MW, Young J, Moodie E, Rollet-Kurhajec KC, Schwartzman K, Greenaway C, Cooper C, Cox J, Gill J, Hull M, Walmsley S, Klein MB. Changes in quality of life, healthcare use, and substance use in HIV/hepatitis C coinfected patients after hepatitis C therapy: a prospective cohort study. HIV CLINICAL TRIALS 2015; 16:100-10. [DOI: 10.1179/501100000024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
32
|
Bennell MC, Qiu F, Micieli A, Ko DT, Dorian P, Atzema CL, Singh SM, Wijeysundera HC. Identifying predictors of cumulative healthcare costs in incident atrial fibrillation: a population-based study. J Am Heart Assoc 2015; 4:jah3938. [PMID: 25907124 PMCID: PMC4579933 DOI: 10.1161/jaha.114.001684] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Atrial fibrillation (AF) has substantial impacts on healthcare resource utilization. Our objective was to understand the pattern and predictors of cumulative healthcare costs in AF patients after incident diagnosis in an emergency department (ED). Methods and Results Patients discharged after a first presentation of AF to an ED in Ontario, Canada, were identified from April 1, 2005, through March 31, 2010. Per‐patient cumulative healthcare costs were determined until death or March 31, 2012. Join‐point analyses identified clinically relevant cost phases. Hierarchical generalized linear models with a logarithmic link and gamma distribution determined predictors of cost per phase. Our cohort was 17 980 patients. During a mean follow‐up of 3.9 years, 17.1% of patients died. Three distinct cost phases were identified: 2‐month post–index ED visit phase, 12‐month predeath phase, and a stable/chronic phase. The mean cost per patient in the first month post–index ED visit was $1876 (95% CI $1822 to $1931), $8050 (95% CI $7666 to $8434) in the month before death, and $640 (95% CI $624 to $655) per month for the stable/chronic phase. The main cost component in the post‐index phase was physician services (32% of all costs) and hospitalizations for the predeath phase (72% of all costs). The CHA2DS2‐VASc clinical risk score was a strong predictor of costs (rate ratio 1.91 and 5.08 for score of 7 versus score of 0 in predeath phase and postindex phase, respectively). Conclusions There are distinct phases of resource utilization in AF, with highest costs in the predeath phase.
Collapse
Affiliation(s)
- Maria C Bennell
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.)
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (F.Q., D.T.K., H.C.W.)
| | - Andrew Micieli
- Faculty of Medicine, University of Ottawa, Ontario, Canada (A.M.)
| | - Dennis T Ko
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.) Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (F.Q., D.T.K., H.C.W.) Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (D.T.K., P.D., H.C.W.)
| | - Paul Dorian
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (D.T.K., P.D., H.C.W.) Division of Cardiology and Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada (P.D.)
| | - Clare L Atzema
- Trauma, Emergency and Critical Care Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada (C.L.A.) Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (C.L.A., H.C.W.)
| | - Sheldon M Singh
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.)
| | - Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (M.C.B., D.T.K., S.M.S., H.C.W.) Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (F.Q., D.T.K., H.C.W.) Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (D.T.K., P.D., H.C.W.) Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (C.L.A., H.C.W.)
| |
Collapse
|
33
|
Wong WWL, Tu HA, Feld JJ, Wong T, Krahn M. Cost-effectiveness of screening for hepatitis C in Canada. CMAJ 2015; 187:E110-E121. [PMID: 25583667 DOI: 10.1503/cmaj.140711] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The seroprevalence of hepatitis C virus (HCV) infection among Canadians is estimated at 0.3% to 0.9%. Of those with chronic HCV infection, 10% to 20% will experience advanced liver disease by 30 years of infection. Targeted screening seems a plausible strategy. We aimed to estimate the health and economic effects of various screening and treatment strategies for chronic HCV infection in Canada. METHODS We used a state-transition model to examine the cost-effectiveness of 4 screening strategies: no screening; screen and treat with pegylated interferon plus ribavarin; screen and treat with pegylated interferon and ribavarin-based direct-acting antiviral agents; and screen and treat with interferon-free direct-acting antivirals. We considered Canadian residents in 2 age groups: 25-64 and 45-64 years of age. We obtained model data from the literature. We predicted deaths related to chronic HCV infection, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. RESULTS We found that screening and treating would prevent at least 9 HCV-related deaths per 10,000 persons screened over the lifetime of the cohort. Screening was associated with QALY increases of 0.0032 to 0.0095 and cost increases of $124 to $338 per person, which translated to an incremental cost-effectiveness ratio of $34,359 to $44,034 per QALY gained, relative to no screening, depending on age group screened and antiviral therapy received. INTERPRETATION A selective one-time HCV screening program for people 25-64 or 45-64 years of age in Canada would likely be cost-effective. Identification of silent cases of chronic HCV infection and the offer of treatment when appropriate could extend the lives of Canadians at reasonable cost.
Collapse
Affiliation(s)
- William W L Wong
- Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont.
| | - Hong-Anh Tu
- Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont
| | - Jordan J Feld
- Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont
| | - Tom Wong
- Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont
| |
Collapse
|
34
|
Jozaghi E. A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada. Harm Reduct J 2014; 11:30. [PMID: 25395278 PMCID: PMC4251950 DOI: 10.1186/1477-7517-11-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. METHODS The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). RESULTS The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. CONCLUSIONS Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.
Collapse
Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
| | | |
Collapse
|
35
|
Jozaghi E, Reid AA, Andresen MA, Juneau A. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:31. [PMID: 25091704 PMCID: PMC4123501 DOI: 10.1186/1747-597x-9-31] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. METHODS The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. RESULTS The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. CONCLUSIONS Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.
Collapse
Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
| | | | | | | |
Collapse
|
36
|
Grebely J, Bilodeau M, Feld JJ, Bruneau J, Fischer B, Raven JF, Roberts E, Choucha N, Myers RP, Sagan SM, Wilson JA, Bialystok F, Tyrrell DL, Houghton M, Krajden M. The Second Canadian Symposium on hepatitis C virus: a call to action. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 27:627-32. [PMID: 24199209 PMCID: PMC3816942 DOI: 10.1155/2013/242405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/15/2013] [Indexed: 02/07/2023]
Abstract
In Canada, hepatitis C virus (HCV) infection results in considerable morbidity, mortality and health-related costs. Within the next three to 10 years, it is expected that tolerable, short-duration (12 to 24 weeks) therapies capable of curing >90% of those who undergo treatment will be approved. Given that most of those already infected are aging and at risk for progressive liver disease, building research-based interdisciplinary prevention, care and treatment capacity is an urgent priority. In an effort to increase the dissemination of knowledge in Canada in this rapidly advancing field, the National CIHR Research Training Program in Hepatitis C (NCRTP-HepC) established an annual interdisciplinary Canadian Symposium on Hepatitis C Virus. The first symposium was held in Montreal, Quebec, in 2012, and the second symposium was held in Victoria, British Columbia, in 2013. The current article presents highlights from the 2013 meeting. It summarizes recent advances in HCV research in Canada and internationally, and presents the consensus of the meeting participants that Canada would benefit from having its own national HCV strategy to identify critical gaps in policies and programs to more effectively address the challenges of expanding HCV screening and treatment.
Collapse
Affiliation(s)
- Jason Grebely
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
| | - Marc Bilodeau
- Liver Unit, Department of Medicine, Université de Montréal, Montréal, Québec
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University of Toronto, Toronto, Ontario
| | | | | | - Jennifer F Raven
- Canadian Institutes of Health Research – Institute of Infection and Immunity, Laurier, Québec
| | | | - Norma Choucha
- Liver Unit, Department of Medicine, Université de Montréal, Montréal, Québec
| | - Rob P Myers
- Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta
| | - Selena M Sagan
- Department of Microbiology & Immunology, McGill University, Montreal, Quebec
| | - Joyce A Wilson
- Department of Microbiology and Immunology, University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - D Lorne Tyrrell
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta
| | - Michael Houghton
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia
- University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
37
|
Lin SH, Chen KC, Lee SY, Hsiao CY, Lee IH, Yeh TL, Chen PS, Lu RB, Yang YK. The economic cost of heroin dependency and quality of life among heroin users in Taiwan. Psychiatry Res 2013; 209:512-7. [PMID: 23477899 DOI: 10.1016/j.psychres.2013.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 08/22/2012] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
Abstract
Heroin dependence may cause an economic burden and has an impact on quality of life (QOL). However, assessments of economic cost are scarce and the relationship between economic cost and QOL is unclear in the Asian population. In the present study, an established questionnaire was modified to assess the economic cost and its association with QOL. A total of 121 volunteer subjects in a methadone maintenance therapy programme and 157 normal controls were enrolled. The total economic cost of heroin dependency is US$ 18,310 per person-year. The direct cost is US$ 11,791 per person-year (64% of the total cost), mostly consisting of the cost of heroin and other illegal drugs. The indirect cost is US$ 6519 (36% of the total cost) per person-year, most of which arises from productivity loss caused by unemployment and incarceration. The QOL of heroin-dependent patients is poorer than that of healthy controls in all domains. The overall QOL is negatively related to direct cost and total cost. The economic cost of heroin dependency is huge, equal to 1.07 times the average gross domestic product per capita. Reduction of the economic cost to society and the economic burden for heroin users is important.
Collapse
Affiliation(s)
- Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Reasons for Nonattendance across the Hepatitis C Disease Course. ISRN NURSING 2013; 2013:579529. [PMID: 24109517 PMCID: PMC3786544 DOI: 10.1155/2013/579529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/02/2013] [Indexed: 02/06/2023]
Abstract
This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.
Collapse
|
39
|
Turner SJ, Brown J, Paladino JA. Protease inhibitors for hepatitis C: economic implications. PHARMACOECONOMICS 2013; 31:739-751. [PMID: 23839698 DOI: 10.1007/s40273-013-0073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Chronic hepatitis C virus (HCV) infection, a blood-borne virus, is the leading cause of chronic liver disease and liver transplantation worldwide. Chronic HCV infection is usually asymptomatic in the early stages of the disease, making an estimation of the total population affected difficult to elicit. The gold standard treatment option to date has been a combination of pegylated interferon and ribavirin. Recent developments have led to the introduction of two protease inhibitors for use in chronic HCV-boceprevir and telaprevir. Phase III studies have shown both agents have the potential to significantly increase the probability of attaining a sustained virologic response (the primary outcome of interest in chronic HCV) in genotype 1 infections. However, the added cost of these agents also presents the need for decision makers to determine their place on drug formularies. The protease inhibitors are to be administered as triple therapy with the existing gold standard. However, significant variation exists as to the proposed duration of triple therapy, use of lead-in pegylated interferon and ribavirin and subsequent pegylated interferon therapy after finishing the course of triple therapy. Treatment algorithms also exist for the use of stopping rules in the case of early non-responders.The aim of this review is to highlight the current understanding of the economic impact protease inhibitors may have on health care systems and considerations required in the treatment of HCV. Economic and health-related quality of life issues are addressed from multiple viewpoints. The major aspects of the economic evaluations, to date, that included triple therapy as an alternative in the treatment of chronic HCV are brought to light. Future economic evaluations in alternative settings would be useful. The review also emphasizes the challenges for future research. This includes the potential for new therapies to no longer require inclusion of pegylated interferon and/or ribavirin, as well as the use of protease inhibitors in non-genotype 1 patients or those with significant co-morbidities such as HIV/AIDS.
Collapse
Affiliation(s)
- Stuart J Turner
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 205 Kapoor Hall, Buffalo, NY 14214, USA
| | | | | |
Collapse
|
40
|
Jozaghi E, Reid AA, Andresen MA. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:25. [PMID: 23837814 PMCID: PMC3710233 DOI: 10.1186/1747-597x-8-25] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022]
Abstract
Background This paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users. Methods By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal. Results With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV. Conclusions Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.
Collapse
Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6.
| | | | | |
Collapse
|
41
|
Yu A, Spinelli JJ, Cook DA, Buxton JA, Krajden M. Mortality among British Columbians testing for hepatitis C antibody. BMC Public Health 2013; 13:291. [PMID: 23547940 PMCID: PMC3626540 DOI: 10.1186/1471-2458-13-291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/13/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major preventable and treatable cause of morbidity and mortality. The ability to link population based centralized laboratory HCV testing data with administrative databases provided a unique opportunity to compare mortality between HCV seronegative and seropositive individuals. Through the use of laboratory testing patterns and results, the objective of this study was to differentiate the viral effects of mortality due to HCV infection from risk behaviours/activities that are associated with acquisition of HCV infection. METHODS Serological testing data from the British Columbia (BC) Centre for Disease Control Public Health Microbiology and Reference Laboratory from 1992-2004 were linked to the BC Vital Statistics Agency death registry. Four groups of HCV testers were defined by their HCV antibody (anti-HCV) testing patterns: single non-reactive (SNR); serial multiple tested non-reactive (MNR); reactive at initial testing (REAC); and seroconverter (SERO) (previously seronegative followed by reactive, a marker for incident infection). Standardized mortality ratios (SMRs) were calculated to compare the relative risk of all cause and disease specific mortality to that of the BC population for each serological group. Time dependent Cox proportional hazard regression was used to compare hazard ratios (HRs) among HCV serological groups. RESULTS All anti-HCV testers had higher SMRs than the BC population. Referent to the SNR group, the REAC group had higher risks for liver (HR: 9.62; 95% CI=8.55-10.87) and drug related mortality (HR: 13.70; 95% CI=11.76-16.13). Compared to the REAC group, the SERO group had a lower risk for liver (HR: 0.53; 95% CI=0.24-0.99), but a higher risk for drug related mortality (HR: 1.54; 95% CI=1.12-2.05). CONCLUSIONS These findings confirm that individuals who test anti-HCV positive have increased mortality related to progressive liver disease, and that a substantial proportion of the mortality is attributable to drug use and risk behaviours/activities associated with HCV acquisition. Mortality reduction in HCV infected individuals will require comprehensive prevention programming to reduce the harms due to behaviours/activities which relate to HCV acquisition, as well as HCV treatment to prevent progression of chronic liver disease.
Collapse
Affiliation(s)
- Amanda Yu
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - John J Spinelli
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Cancer Agency, Vancouver, BC, Canada
| | - Darrel A Cook
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
42
|
John-Baptiste A, Yeung MW, Leung V, van der Velde G, Krahn M. Cost effectiveness of hepatitis C-related interventions targeting substance users and other high-risk groups: a systematic review. PHARMACOECONOMICS 2012; 30:1015-1034. [PMID: 23050771 DOI: 10.2165/11597660-000000000-00000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE In developed countries, injection drug users have the highest prevalence and incidence of hepatitis C virus (HCV) infection. Clinicians and policy makers have several options for reducing morbidity and mortality related to HCV infection, including preventing new infections, screening high-risk populations, and optimizing uptake and delivery of antiviral therapy. Cost-effectiveness analyses provide an estimate of the value for money associated with adopting healthcare interventions. Our objective was to determine the cost effectiveness of hepatitis C interventions (prevention, screening, treatment) targeting substance users and other groups with a high proportion of substance users. METHODS We conducted a systematic search of MEDLINE, EMBASE, CINAHL, HealthSTAR and EconLit, and the grey literature. Studies were critically appraised using the Drummond and Jefferson, Neumann et al. and Philips et al. checklists. We developed and applied a quality appraisal instrument specific to cost-effectiveness analyses of HCV interventions. In addition, we summarized cost-effectiveness estimates using a single currency and year ($US, year 2009 values). RESULTS Twenty-one economic evaluations were included, which addressed prevention (three), screening (ten) and treatment (eight). The quality of the analyses varied greatly. A significant proportion did not incorporate important aspects of HCV natural history, disease costs and antiviral therapy. Incremental cost-effectiveness ratios (ICERs) ranged from dominant (less costly and more effective) to $US603,352 per QALY. However, many ICERs were less than $US100,000 per QALY. Screening and treatment interventions involving pegylated interferon and ribavirin were generally cost effective at the $US100,000 per QALY threshold, with the exception of some subgroups, such as immune compromised patients with genotype 1 infections. CONCLUSIONS No clear consensus emerged from the studies demonstrating that prevention, screening or treatment provides better value for money as each approach can be economically attractive in certain subgroups. More high-quality economic evaluations of preventing, identifying and treating HCV infection in substance users are needed.
Collapse
|
43
|
Chen A, Bushmeneva K, Zagorski B, Colantonio A, Parsons D, Wodchis WP. Direct cost associated with acquired brain injury in Ontario. BMC Neurol 2012; 12:76. [PMID: 22901094 PMCID: PMC3518141 DOI: 10.1186/1471-2377-12-76] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada. METHODS A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer's perspective. RESULTS Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components. CONCLUSIONS The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.
Collapse
Affiliation(s)
- Amy Chen
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
44
|
Klein MB, Rollet KC, Saeed S, Cox J, Potter M, Cohen J, Conway B, Cooper C, Côté P, Gill J, Haase D, Haider S, Hull M, Moodie E, Montaner J, Pick N, Rachlis A, Rouleau D, Sandre R, Tyndall M, Walmsley S. HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality. HIV Med 2012; 14:10-20. [PMID: 22639840 DOI: 10.1111/j.1468-1293.2012.01028.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) has emerged as an important health problem in the era of effective HIV treatment. However, very few data exist on the health status and disease burden of HIV/HCV-coinfected Canadians. METHODS HIV/HCV-coinfected patients were enrolled prospectively in a multicentre cohort from 16 centres across Canada between 2003 and 2010 and followed every 6 months. We determined rates of a first liver fibrosis or endstage liver disease (ESLD) event and all-cause mortality since cohort enrolment and calculated standardized mortality ratios compared with the general Canadian population. RESULTS A total of 955 participants were enrolled in the study and followed for a median of 1.4 (interquartile range 0.5-2.3) years. Most were male (73%) with a median age of 44.5 years; 13% self-identified as aboriginal. There were high levels of current injecting drug and alcohol use and poverty. Observed event rates [per 100 person-years; 95% confidence interval (CI)] were: significant fibrosis (10.21; 8.49, 12.19), ESLD (3.16; 2.32, 4.20) and death (3.72; 2.86, 4.77). The overall standardized mortality ratio was 17.08 (95% CI 12.83, 21.34); 12.80 (95% CI 9.10, 16.50) for male patients and 28.74 (95% CI 14.66, 42.83) for female patients. The primary causes of death were ESLD (29%) and overdose (24%). CONCLUSIONS We observed excessive morbidity and mortality in this HIV/HCV-coinfected population in care. Over 50% of observed deaths may have been preventable. Interventions aimed at improving social circumstances, reducing harm from drug and alcohol use and increasing the delivery of HCV treatment in particular will be necessary to reduce adverse health outcomes among HIV/HCV-coinfected persons.
Collapse
Affiliation(s)
- M B Klein
- Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Myers RP, Cooper C, Sherman M, Lalonde R, Witt-Sullivan H, Elkashab M, Harris P, Balshaw R, Usaty C, Marrotta PJ. Outcomes of chronic hepatitis C therapy in patients treated in community versus academic centres in Canada: final results of APPROACH (a prospective study of peginterferon alfa-2a and ribavirin at academic and community centres in Canada). CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:503-10. [PMID: 21912762 PMCID: PMC3202358 DOI: 10.1155/2011/698780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/04/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND In patients chronically infected with the hepatitis C virus (HCV), it is not established whether viral outcomes or health-related quality of life (HRQoL) differ between individuals treated at academic or community centres. METHODS In the present observational study, adults with chronic HCV were treated with peginterferon alfa-2a 180 ìg⁄week plus ribavirin at 45 Canadian centres (16 academic, 29 community). The primary efficacy end point was sustained virological response (SVR). Other outcome measures included HRQoL (assessed using the 36-item Short-Form Health Survey), heath resource use, and workplace productivity and absences within a 60-day interval. RESULTS In treatment-naive patients infected with HCV genotype 1, significantly higher SVR rates were achieved in those treated at academic (n=54) compared with community (n=125) centres (52% versus 32% [P=0.01]), although rates of dosage reduction and treatment discontinuation were similar across settings. SVR rates among patients infected with genotype 2⁄3 were similar between academic (n=59) and community (n=100) centres (64% versus 67% [P=0.73]). Following antiviral therapy, patients with genotype 1 who achieved an SVR (n=67) had significantly higher mean scores on the physical (P=0.005) and mental components of the 36-item Short-Form Health Survey (P=0.043) compared with those without an SVR (n=111). In contrast, HRQoL scores were similar in HCV genotype 2⁄3 patients with and without an SVR. There were no differences in workplace productivity or absences between patients with and without an SVR. The most frequently used health care resources by all patients were visits and phone calls to hepatitis nurses, and general practice or walk-in clinics. CONCLUSION Patients infected with HCV genotype 1 achieved higher SVR rates when treated at academic rather than community centres in Canada. The reasons for this difference require additional investigation.
Collapse
|
46
|
Pay now or pay (more) later: tracking the costs of hepatitis C infection. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 24:715-6. [PMID: 21165378 DOI: 10.1155/2010/526295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|