Presence of hepatitis C (HCV) infection in Baby Boomers with Medicare is independently associated with mortality and resource utilisation

Summary

Background

Hepatitis C virus is common among Baby Boomers (BB). As this cohort ages, they will increasingly become Medicare eligible.

Aim

To evaluate resource utilisation and mortality of BB-Medicare recipients with HCV.

Methods

We used in-patient and out-patient Medicare databases (2005–2010). HCV was identified using ICD-9 codes. Outcomes included resource utilisation [payment/case and in-patient length of stay (LOS)] and short-term mortality.

Results

Of 1 153 862 BB Medicare recipients (2005–2010), 3.2% (N = 37 365) had HCV. During this period, in-patient Medicare-BB (39 793–55 235) and their claims (78 924–106 232) increased. Furthermore, their overall mortality increased from 8.94% to 10.25% (P < 0.0001). In multivariate analysis, HCV [OR = 1.23 (1.16–1.29)], older age [OR = 1.98 (1.82–2.14)], male gender [OR = 1.25 (1.22–1.29)], ESRD [OR = 1.31 (1.26–1.36)], Charlson score [OR = 1.41 (1.40–1.42)] and LOS [OR = 1.02 (1.02–1.02)] predicted mortality. LOS decreased from 12.98 to 11.74 days (P < 0.0001), whereas total payments increased from $22 157 to $23 185 (P < .0001). During the study, the number of out-patient Medicare BB patients (123 097–192 110) and claims (863 978–1 340 260) also increased. Furthermore, overall mortality increased from 3.15% to 3.31% (P = 0.0131). Again, HCV [OR = 1.23 (1.16–1.30)], older age [OR = 2.03 (1.89–2.17)], ESRD [OR = 3.40 (3.28–3.51)], disabled status [OR = 1.49 (1.40–1.58)] and Charlson score [OR = 1.39 (1.38–1.40)] predicted mortality. Annual total out-patient payments increased from $3781 to $4001 (P < 0.0001). HCV [36.04% [34.28–37.82%)], 45–49 age [4.21% (3.14–5.28%)], ESRD [966.31% (954.86–977.88%)], disabled status [43.22% (41.67–44.80%)], Charlson score [46.78% (46.31–47.26%)] and study year [2.72% (2.58–2.85%)] independently predicted increases in payments.

Conclusions

In BB Medicare recipients, diagnosis of HCV is independently associated with higher mortality and resource utilisation.

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