Cost of Illness of Primary Biliary Cholangitis in Lombardia

Abstract

The burden of Primary Biliary Cholangitis (PBC) has never been characterised at population-level. We aimed to estimate the cost of illness of PBC in Lombardy Region, Italy. PBC cases were defined as individuals with at least a single episode of hospitalization attributed to code 571.6 (ICD–9 – Biliary Cirrhosis) or with a disease exemption code 008.571.6, (Biliary Cirrhosis) from year 2007 to year 2017. Case finding was further refined excluding patients not receiving ursodeoxycholic acid and those treated with antivirals for hepatitis B and C. Data are representative of the context of Lombardia Region (located in Northern Italy, with a population of about 10 million inhabitants) and costs are calculated assuming the perspective of Regional Health Service. Only health services considered clinically related to the PBC diagnose were considered, and direct costs were estimated only for services related to PBC in 2017 and subdivided as outpatient and inpatient activities. The point of view assumed in the analysis is that of the Regional Health Service of Lombardia Region. We identified 970 adult patients, 810 (83.5 %) were females, with a mean age of 61 years. Direct medical costs in 2017 were equal to € 916,763, with € 459,506 (50.3 %) deriving from inpatient activities. These were mostly due to liver transplant (30.5 %) and cirrhosis complication (20.6 %). Costs from outpatient activities were equal to € 109,090 (11.9 %). Of note, only 52.8 % were prescribed to perform biochemicals tests: of those 72 % had alkaline phosphatase checked. Cost of drugs used to manage was € 345,167 (37.7 %). The main direct costs component for PBC are inpatient activities due to the progression of disease, which might be potentially reduced as a result of the adoption of new treatments. The analysis of outpatient's activities suggests an inadequate monitoring activity of patients affected by PBC.