Hospitalization costs of hepatitis B in Italy Francesco Di Nardo

Thanks to vaccination policies, Italy has a low (<1%) prevalence of hepatitis B virus (HBV) infection. However, costs related to HBV are still significant, especially in those who develop sequelae and require hospital services, which represent a large proportion of the expenditure of the health system for HBV. Also, the immigrant infected population is growing and has exceeded 200,000 units. In this study we estimated the direct costs due to hospitalization of HBV infection in Italy in the years 2008-2010 in order to model the impact of future cases. A literature search was carried out in order to draw the outcome tree of HBV infection. All HBV-related relevant health outcomes were considered. Data on hospitalizations were collected from the hospital discharge database of the Italian Ministry of Health, containing medical and financial records of each patient and the applicable DRGs. We retrieved information on HBV patients using the ICD9-CM codes identifying HBV related conditions in primary diagnosis. If such conditions were reported in secondary diagnosis, we only included cases with a DRG strictly related to HBV. Finally, for each health status we calculated the average cost and the number of affected subjects. We considered the following health outcomes: acute symptomatic infection; fulminant infection; chronic infection; cirrhosis; hepatocellular carcinoma (HCC). Delta super-infection was not considered (its prevalence is negligible). In 2008-2010, 10,105 hospital admissions for HBV were registered. The total estimated costs were 43,035,111E. Average expenditure per patient was 4,259E, but increased with the severity of the disease. Indeed, complications were associated with higher rates of liver transplants and accounted for most of the expenditure: on average, 940 cirrhosis patients cost 7,304E, 785 HCC patients cost 8,579E and 733 patients affected from both conditions cost 11,096E. Hospitalization costs of HBV in Italy are still high, but may change in an unpredictable way. These changes may be significant and due either to variations in the number of infected subjects, and to a changing distribution of complications. The estimates of hospitalization costs will allow to model future economic burden taking into consideration new epidemiological data. Key messages Hospitalization costs of HBV in Italy are still high (average cost per patient: 4,259E). Complications are associated with higher rates of liver transplants and account for most of the expenditure. Hospitalization costs may change in an unpredictable way. The estimates of hospitalization costs will allow to model future economic burden taking into consideration new epidemiological data