Chronic Hepatitis C Disease in North Carolina: Epidemiology, Hospital Utilization Trends, and Implications for State Policy Change
Creators: name: Carswell, Lori K.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2006

description: Chronic infection with the hepatitis C virus (HCV) is recognized as a rapidly growing global, national, and local public health problem. More than 3 million people in the United States, and 130 million people worldwide, are living with chronic HCV infection. Chronic HCV can progress to serious, debilitating forms of liver disease, including advanced cirrhosis and liver cancer. Available treatments for HCV are expensive and not always effective, and there is no vaccine to prevent HCV. Published mathematical models and data analyses have predicted and documented dramatic growth in the number of patients in the United States with advanced disease related to HCV, with corresponding increases in hospitalizations and medical costs. However, these analyses used data only through 2001, and were not conducted at the state (North Carolina) level. The objective of this paper is to summarize the current state of knowledge about HCV in North Carolina, with an emphasis on the impact or burden of the disease. With this assessment as a base, the paper identifies areas for further research and policy change. Available state-level epidemiologic data, hospital utilization data, and Medicaid claims data were analyzed to investigate the recent and current impact of HCV in North Carolina. Trends in HCV-associated hospital stays and charges were measured by patient age group, gender, and payer. Long-term (1996-2004) growth rates in hospital stays and charges attributable to HCV were observed to be approximately 20% per year, with significant variation by age group. These high rates of growth are not explained by overall North Carolina hospital utilization trends, which demonstrate much smaller growth rates over the same time periods. The majority of HCV-related hospital stays and charges are experienced by males overall, and by both males and females aged 35-54. However, the highest annual growth rates in stays and charges are now seen in the 55-64 age group, reflecting the aging of the population chronically infected with HCV and the gradual progression of HCV infection to severe forms of liver disease. North Carolina hospital charges attributable to HCV were over $70 million in 2004 (2005 dollars); charges could easily be over $100 million in 2006-05 if current trends continue. The North Carolina Medicaid program has also experienced growth in the number of recipients with an HCV diagnosis, and associated paid claims amounts, from 2003 through 2005. The number of annual deaths associated with hospital stays for HCV in North Carolina has grown significantly over the past several years. These findings suggest that there is a need for the morbidity, mortality, and societal costs associated with HCV to be more effectively addressed and controlled in North Carolina. Policy changes are recommended based on the burden of HCV disease and the lack of public health capacity to address HCV in North Carolina. Free or low-cost HCV screening is generally not available in public health clinics or similar settings, and is needed in order to identity, counsel, and treat HCV patients at risk for serious liver-related disease. In addition, improved surveillance systems and an HCV patient registry would help to monitor patient progress over time, inform interventions, and improve outcomes. Additional research is needed to identify the regions of North Carolina most in need of access to HCV testing and treatment, and also to identity the locations and populations in which testing programs may be most cost-effective and successful.