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THE BURDEN OF HEPATITIS C VIRUS INFECTION IS GROWING: A CANADIAN POPULATION-BASED STUDY OF HOSPITALIZATIONS FROM 1994 TO 2004
RP Myers1, MF Liu2, AA Shaheen1
1Liver Unit, Division of Gastroenterology, University of Calgary, Calgary, Alberta; 2Health System Analysis Unit; Quality, Safety and Health Information, Calgary Health Region, Calgary, Alberta
BACKGROUND: Nearly 1% of Canadians are infected with the hepatitis C virus (HCV). Simulation analyses have suggested that HCV will place an increasing burden on the health care system as the infected population ages, but supportive clinical data is limited. We studied temporal trends in HCV-related hospitalizations and predictors of increased health care utilization from a Canadian population-based perspective.
METHODS: We used an administrative hospitalization database from the Calgary Health Region to identify patients admitted for HCV between 1994 and 2004. The primary outcomes were liver-related HCV hospitalizations, length of stay, hospital costs, and in-hospital mortality. Average annual growth rates in outcomes were calculated using Poisson and linear regression models and subgroup analyses conducted according to age, gender, and HIV/HCV coinfection status.
RESULTS: Between 1994 and 2004, there were 4,002 HCV-related hospitalizations in the Calgary Health Region; 22% were liver-related. Liver-related hospitalizations, lengths of stay, and in-hospital mortality increased approximately 4-fold or an average of 15-18% annually (P<0.0005). Patients aged 40-59 years and HIV/HCV-coinfected patients experienced the largest average annual growth rates (19-27% and 30-40%, respectively; P<0.0005), reflecting the accelerated natural history of HCV in these subgroups. Hospital costs for liver-related HCV hospitalizations increased an average of 41% annually (P=0.001) between 2000 and 2004. The average annual increase in liver-related hospitalizations remained significant in a sensitivity analysis even when 75% of HCV cases were underreported in 1994.
CONCLUSIONS: Our findings confirm the growing burden of HCV on the Canadian health care system. Strategies to prevent HCV infections and maximize the dissemination and most effective use of potentially curative antiviral therapies are necessary to reduce these trends.