Finally, the data may also not be easily generalized to nonmanaged-care populations. We observed a consistent increase in healthcare costs and utilization with progression of HCV-related liver disease, yet only a small proportion of patients in this analysis (18%) received combination antiviral therapy of pegylated interferon with ribavirin. This finding implies that a majority of patients who might have benefited from antiviral therapy were either not offered treatment, were not eligible, or did not consent to treatment. This observation is consistent with the finding that only a small proportion of chronic HCV patients (i.e., less than 30%) receive treatment

with peginterferon plus ribavirin.19-22

The nature of a claims database prevents us from determining why such a low percentage selleckchem of patients received treatment. Although decompensated cirrhosis represents a contraindication to treatment with interferon-based therapy, the results of this analysis suggested that treatment for patients with less severe forms of CHC (NCD and CC) should be considered in order HIF-1�� pathway to potentially prevent liver disease progression and to limit direct healthcare costs. Clearly, treatment should be offered before the development of comorbid conditions that preclude such therapy. Benefits associated with successful treatment for CHC (sustained virological response) include durable eradication of HCV infection, improved health-related quality of life, regression of hepatic fibrosis, and reduction in the incidence of HCC, liver-related mortality, and all-cause mortality.23-28 Our study did not consider screening for HCV among DNA ligase those at high risk, or include the costs of the recently approved protease inhibitors (boceprevir and telaprevir, which were not approved until after this study was conducted).

However, our data intuitively demonstrate that, in the future, the costs of screening and treatment must be offset by the costs of ignoring these options and allowing chronic HCV disease to progress from NCD to CC and ESLD. We have clearly shown that the direct costs associated with chronic HCV are considerable, averaging over $24,000 annually for all patients and $60,000 for those with advanced liver disease. A recent study showed that birth-cohort screening of all patients born between 1945 and 1965 is cost-effective, averaging $2,874 per new case identified. If the costs of treatment are included, this adds $15,700 per quality-adjusted life-year (QALY) assuming peginterferon plus ribavirin is used, or $35,700 per QALY saved assuming that a protease inhibitor is used in combination with peginterferon plus ribavirin.29 We have shown that the current cost of HCV disease management would likely offset these expenses.