Researchers from Denmark, Sweden, Norway and Finland (the NORDynamIC project group) have observed that depressive symptoms in patients with hepatitis C virus infection are commonly overlooked in routine clinical interviews, and that treatment-induced depression compromises the outcome of hepatitis C virus therapy. A second U.S. study found that patients with chronic infection had lower (work) productivity and incurred higher medical benefit costs than those without hepatitis C virus.
Hepatitis C virus is a blood-born infection causing inflammation and destruction of liver cells. When inflammation lasts longer than six months there is ongoing liver cell injury which is defined as chronic hepatitis C virus. The standard treatment protocol for chronic hepatitis C virus is weekly injections of peg-interferon alfa-2a in combination with daily oral ribavirin for 24 to 48 weeks. However, this combination treatment can lead to major depression or other psychiatric complications in a number of hepatitis C virus patients which may require premature termination of the antiviral therapy.
Peter Leutscher and colleagues estimated the value of routine medical interviews in diagnosing depression in chronic hepatitis C virus patients receiving peg-interferon/ribavirin therapy using the Major Depression Inventory (MDI). The MDI is a self-rating depression scale with a dual functionality in diagnosing major depression and in measurement of depression severity. Of the 325 hepatitis C virus patients enrolled in the study, 6% were observed with major depression at baseline. Among the remaining 306 patients, 37% (n=114) developed depression while on hepatitis C virus combination therapy. “According to the MDI criteria, we found that only 32% of the 114 patients with major depression were correctly diagnosed during routine medical interviews,” noted Dr. Leutscher.
Researchers also noted that the emergence of major depression frequently led to premature discontinuation of the peg-interferon/ribavirin therapy. Those patients with higher MDI scores (30 and over) were more likely to have a diminished treatment outcome. “A self-report instrument such as the MDI scale may be a useful tool for health providers to identify patients at risk for depression during hepatitis C virus therapy,” recommended Dr. Leutscher.
Another hepatitis C virus study compared healthcare benefit costs and productivity issues for patients with and without chronic hepatitis C virus infection. A total of 339,456 U.S. subjects were evaluated-1664 employees with hepatitis C virus and 337,792 in the healthy control. Rich Brook, lead study author said, “We found that employees with hepatitis C virus infection experience significant health-related work absences, greater health benefit costs, and further comorbidity than those without infection.”
Research results found hepatitis C virus infected workers had 4.15 more total annual absence days and processed 7.5% fewer units of work per hour than those in the control group. Healthcare benefit costs were also significantly higher in the hepatitis C virus group with a total incremental difference of $8,352 per year, including $490 in indirect (absence) costs.
Prior studies estimate that 180 million people are affected by hepatitis C virus worldwide, and currently a vaccine to treat this disease is not available. Experts project that hepatitis C virus will lead to a substantial health and economic burden over the next 10 to 20 years. “Our research supports this finding and provides a real world evaluation of hepatitis C virus’s impact on productivity and healthcare benefit costs in the workplace,” concluded Mr. Brook.
References:
1. Peter Leutscher, et al. Evaluation of Depression as a Risk Factor for Treatment Failure in Chronic Hepatitis C. Hepatology; Published Online: April 29, 2010 DOI: 10.1002/hep.23699
2. Richard A. Brook, et al. The Impact of Hepatitis C Viral (HCV) Infection on Work Absence, Productivity, and Healthcare Benefit Costs. Hepatology; Published Online: May 26, 2010 DOI: 10.1002/hep.23726
