Background and aims
Hepatitis delta is the most severe form of viral hepatitis, causing rapid progression to advanced liver disease. Hepatitis delta is caused by the hepatitis D virus (HDV), a defective RNA virus that requires the presence of the hepatitis B surface antigen (HBsAg) for its complete replication and transmission. This study assesses the healthcare resource utilization and costs associated with HDV infection among adults with chronic HBV infection in the United States.
Using the All-Payer Claims Database (APCD), adult patients (≥18 years) with ≥1 inpatient claim or ≥2 outpatient claims spaced ≥30 days apart for HDV infection based on ICD-9/10-CM diagnosis codes were identified from 01/01/2015 to 12/31/2019. Patients were required to have ≥12 months continuous enrolment before and after their first date of HDV infection diagnosis in the study period. All-cause healthcare-related resource utilization and costs were assessed in the 12 months pre- and post-HDV diagnosis period.
Among 6, 719 adults with HDV who met inclusion criteria, mean total number of all-cause healthcare utilization claims were significantly greater in the postdiagnosis than pre-diagnosis period (20.3 vs 15.9, p<0.0001). Patients had more inpatient admissions (mean,1.6 vs 1.3, p<0.0001), emergency department visits (mean,1.1 vs 0.9, p<0.0001), outpatient visits (mean, 10.6 vs 7.9, p<0.0001), and pharmaceutical claims (mean, 8.2 vs 6.7, p<0.0001) post-diagnosis compared to pre-diagnosis. Furthermore, the mean total annual cost of healthcare services (Figure 1) was significantly greater post-diagnosis than pre-diagnosis (mean, $20,230 vs $16,056, p<0.0001), including inpatient admissions (mean, $8,748 vs $6,876, p<0.0001), outpatient visits (mean, $5,272 vs $4,176, p<0.0001), and pharmaceutical claims (mean, $6, 210 vs $5,004, p<0.0001). Mean emergency department costs were $657 vs $552 (p=0.4346).
In a large national US healthcare claims database, representing ∼80% of the US insured population, patients experienced significantly greater overall healthcare resource utilization and costs following diagnosis of HDV infection. These findings underscore a need for more effective strategies for the screening, diagnosis, and treatment of HDV, which may translate into cost savings for the healthcare system.