Hepatitis D Virus Coinfection Boosts HBV Healthcare Costs

By Marilynn Larkin

December 20, 2019

NEW YORK (Reuters Health) - Hepatitis delta virus (HDV) infection, which occurs only as a co-infection with acute hepatitis B (HBV) or a superinfection with chronic HBV, is associated with higher healthcare utilization and costs than HBV alone, a matched case-control analysis reveals.

"HDV is an important infection globally in those who have HBV, accelerating the progression to end-stage liver disease," Dr. Vinod Rustgi of Robert Wood Johnson Medical School in New Brunswick, New Jersey told Reuters Health by email.

"In the U.S., it is seen mainly in IV drug users and substance abusers but is also transmitted sexually," he said. "Having this infection adds an additional 32% in annual costs per patient. Screening for this infection in high-risk HBV patients is warranted."

Dr. Rustgi and colleagues analyzed healthcare claims from 2,727 HDV cases, matched 1:1 to chronic HBV controls. The mean age was about 46, and about 55% were men.

To assess the burden associated with a new HDV diagnosis, healthcare utilization and cost parameters were aggregated over the 12 months before and after the first HDV diagnosis. In chronic HBV controls, utilization and cost parameters over the 12 months following a randomly selected index date were quantified, for comparison.

As reported in Hepatology, overall, the HDV group had a significantly higher prevalence of substance abuse, sexually transmitted diseases, decompensated cirrhosis, cirrhosis and hepatitis C virus compared to chronic HBV patients.

Compared to pre-HDV baseline, a first HDV diagnosis was associated with significant increases in the total number of healthcare claims (25.61 vs. 28.99) and the total annual healthcare costs ($19,476 vs. $23,605).

Similarly, the case-control analysis indicated higher total claims (28.99 vs. 25.19) and healthcare costs ($23,605 vs. $18,228) with HDV compared to HBV alone.

Further, compared to HBV controls, HDV cases had an adjusted incident rate ratio 1.16 times the total number of annual claims and aIRR 1.32 times the total annual healthcare cost.

Summing up, the authors conclude, "HDV is associated with higher healthcare utilization and cost burden than HBV alone, underscoring the need for improved screening and treatment."

Dr. Rustgi said, "We are working on defining the natural history of this infection, as we have the largest global database of patients with HDV."

Dr. Khurram Bari, assistant professor in the division of Digestive Diseases at the UC College of Medicine in Cincinnati, Ohio, commented by email to Reuters Health, "I agree with the authors that HDV is an underdiagnosed entity in the U.S., mainly due to lack of awareness among healthcare providers. The 13% prevalence in their study is probably an underestimate."

"There is a definite need to improve provider awareness to screen high-risk patients for HDV when they test positive for HBV," he said. At UC, he noted, the standard of care is for GI providers to screen all HBV patients for HDV.

"We also discuss the risk of infection and methods of prevention with our patients who are at high risk for viral hepatitis infection, and offer routine vaccination against HBV, which should be protective for HDV, too," he added.

SOURCE: http://bit.ly/2sKnBg3 Hepatology, online December 5, 2019.