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      Economic Burden of Hepatitis B Virus-Related Diseases: Evidence From Iran

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          Abstract

          Background:

          Hepatitis B infection is still the main cause of chronic liver disease in Iran, which is associated with significant economic and social costs.

          Objectives:

          This study aimed to estimate the financial burden caused by CHB infection and its complications in Iran.

          Patients and Methods:

          Prevalence-based and bottom-up approaches were used to collect the data. Data on direct medical costs were extracted from outpatient medical records in a referral gastroenterology and hepatology research center, inpatient medical records in several major hospitals in Tehran and Shiraz in 2013, and the self-reports of specialists. Data on direct non-medical and indirect costs were collected based on the patients’ self-reports through face-to-face interviews performed in the mentioned centers. To calculate the indirect costs, friction cost approach was used. To calculate the total cost-of-illness in Iran, the total cost per patient at each stage of the disease was estimated and multiplied by the total number of patients.

          Results:

          The total annual cost for the activate population of CHB patients and for those receiving treatment at various disease stages were respectively 450 million and 226 million dollars, with 64% and 70% of which allocated to direct costs respectively, and 36% and 30% to indirect costs respectively. The total direct costs alone for each group were respectively 1.17% and 0.6% of the total health expenditure. Furthermore, the cost spent on drugs encompasses the largest proportion of the direct medical cost for all stages of the disease.

          Conclusions:

          According to the perspectives of payers, patients, and community, CHB infection can be considered as one of the diseases with a substantial economic burden; the disease, specifically in extreme cases, can be too expensive and costly for patients. Therefore, patients should be protected against more severe stages of the disease through proper treatment and early diagnosis.

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          Most cited references29

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          The changing epidemiology of viral hepatitis B in Iran.

          Hepatitis B virus (HBV) prevalence has decreased dramatically in Iranian population during the last decade, and now our country is classified as having low endemicity for hepatitis B infection. Improvement of the people's knowledge about HBV risk factors, national vaccination program since 1993 for all neonates, and vaccination of high risk groups might justify this decrease. The HBV vaccination started in infants in two provinces (Zanjan and Semnan) in 1989, and in 1993 the vaccination was included in the Expanded Program on Immunization (EPI) countrywide. After 13 years of implementation, the coverage has reached an appropriate level from 62% in 1993 to 94% in 2005. Evaluation of risk factors in HBV infected people is important for designing the strategies to control the disease. Intensifying HB vaccination of high risk groups, surveillance of hepatitis B infected subjects, and control on health state of refugees will further decrease the frequency of the disease in our country. Considering all possible routes of transmission in subjects without risk factors for infection is necessary. Changes in the pattern of transmission of new cases of hepatitis B, inform us of changes in the epidemiology of viral hepatitis B infection.
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            Epidemiology and natural history of hepatitis B.

            Hepatitis B virus (HBV) is a common viral pathogen that currently infects an estimated 4 million people worldwide, including 400 million who have chronic infection. Persons with chronic HBV infection are at a lifelong risk of developing hepatocellular carcinoma (HCC) or cirrhosis, or both. Many persons with HBV are unaware that they carry the infection, and, of those who are chronically infected, only a minority receives routine, scheduled follow-up to monitor their disease status. Persons from high-risk populations, especially immigrants from nations where hepatitis B is highly endemic, should be tested for HBV seromarkers and should be vaccinated if they are found to be negative. The natural history of chronic HBV is a dynamic one: patients can fluctuate between periods of active liver inflammation and periods of inactive disease. Disease progression is influenced by various factors, including viral genotype and specific mutations, demographic features, concurrent viral infections, and social and environmental factors. Recent data suggest that antiviral therapy can decrease the risk of liver decompensation and liver-related death and reduce the risk of HCC in selected individuals with active liver disease and severe fibrosis. Persons identified with chronic HBV infection need lifelong, regular monitoring for the development of active liver disease and HCC.
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              • Abstract: found
              • Article: not found

              Comparing methodologies for the cost estimation of hospital services.

              The aim of the study was to determine whether the total cost estimate of a hospital service remains reliable when the cost components of bottom-up microcosting were replaced by the cost components of top-down microcosting or gross costing. Total cost estimates were determined in representative general hospitals in the Netherlands for appendectomy, normal delivery, stroke and acute myocardial infarction for 2005. It was concluded that restricting the use of bottom-up microcosting to those cost components that have a great impact on the total costs (i.e., labour and inpatient stay) would likely result in reliable cost estimates.
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                Author and article information

                Journal
                Hepat Mon
                Hepat Mon
                10.5812/hepatmon
                Kowsar
                Hepatitis Monthly
                Kowsar
                1735-143X
                1735-3408
                25 April 2015
                April 2015
                : 15
                : 4
                : e25854
                Affiliations
                [1 ]Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
                [2 ]Health Human Resource Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
                [3 ]Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
                [4 ]Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, IR Iran
                [5 ]Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Iranian Blood Transfusion Organization, Tehran, IR Iran
                [6 ]Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
                Author notes
                [* ]Corresponding Author: Shekoufeh Nikfar, Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188611883, E-mail: shekoufeh.nikfar@ 123456gmail.com
                Article
                10.5812/hepatmon.15(4)2015.25854
                4427913
                25977694
                ed966663-5c5b-4300-acda-d6d82ca9d3b4
                Copyright © 2015, Kowsar Corp.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                History
                : 09 December 2014
                : 16 February 2015
                : 15 March 2015
                Categories
                Research Article

                Infectious disease & Microbiology
                chb,cost of illness,diseases
                Infectious disease & Microbiology
                chb, cost of illness, diseases

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