(257) Economic Burden of Liver Progression in Patients with Chronic Hepatitis B Virus Infection in the United States

Background: : Chronic Hepatitis B virus[cHBV] infection is a long-term condition associated with a risk of liver disease progression: compensated / decompensated cirrhosis [CC, DC], hepatocellular carcinoma [HCC], and liver transplant [LT].

Objective: : Describe all-cause healthcare resource utilization [HRU] and costs of patients with cHBV following a liver disease progression (“progression”) event in the United States [US].

Methods: : This retrospective cohort study used administrative claims from the Merative™ MarketScan® Database. Patients were first indexed on the chronologically first occurring cHBV infection diagnosis between Jan 2017–Jun 2022 and then re-indexed upon diagnosis of each progression event observed in order of increasing severity: CC, DC, HCC, or LT. Patients aged ≥18 years had no progression events at baseline. For each progression event state, all-cause HRU per year and costs per patient per year [PPPY] (2022 USD) were evaluated from the progression event date until the end of follow-up or the next more severe progression event. Data were analyzed descriptively overall and by payer type.

Results: : A total of 7,661 patients were included (Commercial n=5,303; Medicaid n=1,981; Medicare n=377). Mean (standard deviation [SD]) age 47.2 (12.1) years; 52.7% female. Over a mean (SD) follow-up of 2.8 (1.8) years, 956 (12.5%) patients progressed (CC n=497; DC n=355; HCC n=191; LT n=23) with rates varying by payer: Medicaid 20.3%; Medicare 14.3%; Commercial 9.4%. Except for LT (78.3%), less than half across all progression event types were treated with nucleos(t)ide analogues/Peg-interferon (CC 46.5%; DC 36.6%; HCC 48.2%), and treatment rates differed by payer type being highest for Commercial. Following progression, total costs PPPY increased with progression severity (CC $33,341; DC $56,160; HCC $84,363; LT $207,020). The highest proportion of patients with inpatient (73.9%) and outpatient (78.3%) visits were observed during the LT event state. However, among the other 3 events, patients in the DC event state had the highest proportion with inpatient (67.0%) or ER (65.6%) admission but lowest with outpatient visits (44.2%) relative to CC (32.0%, 46.7%, 50.1%) and HCC (31.4%, 40.3%, 55.0%). Similar trends were noted for the number of visits. Costs and HRU varied by payer type across all progression event types.

Conclusions: : Liver disease progression in cHBV infection incurs substantial economic burden. Results highlight the need for therapies that provide an opportunity for functional cure with the potential of reducing or eliminating these complications.

Sponsorship:: GSK (Study 209383).