A descriptive analysis of both insured and uninsured HBV-related patients is provided in Table . Among the 894 HBV-related patients included in our survey, 347 cases were from Jinan, 374 cases from Qingdao and 173 cases from Liaocheng. There were 849 patients (94.97%) with insurance; 45 (5.03%) without insurance. Most patients (86.35%) had one of three conditions: chronic hepatitis B, compensated cirrhosis or decompensated cirrhosis. Mean age was 45.80 years and over two-thirds were male (641 or 71.70%). The insured group was older than the uninsured group (46.37 vs. 34.89). Most had obtained a high school education or above; only 19.69% were uneducated or only attended primary school. Household monthly income was $438 for the overall sample; $439 for the insured and $411 for the uninsured group. Individual monthly income was $190 for the overall sample; $190 for the insured and $191 for the uninsured.
Characteristics of all HBV-related diseases for insured and uninsured inpatients in Shandong province
Direct total costs for each patient were divided by the number of admissions if the patient had two or more hospital admissions. As shown in Table , the direct costs for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, and primary liver cancer were $2954, $10834, $4552, $7400, $6937, and $10636 respectively. Direct costs for inpatients who were insured were higher than for the uninsured. Proportion of direct medical cost (%) is consistently high, accounting for 91-97% in direct cost. For insured patients, there was a significant difference in the direct costs among the HBV-related diseases with primary liver cancer costing much more.
Inpatient direct costs of all HBV-related diseases (dollar/per admission)
The direct medical cost of acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, and primary liver cancer was $2854, $10114, $4136, $6781, $6400, and $9891, respectively. As shown in Table , outpatient expenditures were highest for primary liver cancer ($1476), followed by decompensated cirrhosis and compensated cirrhosis at $958 and $951, respectively. Hospitalization stay expenditures were highest for severe hepatitis B and primary liver cancer, $9367 and $8209 respectively, followed by compensated cirrhosis and decompensated cirrhosis, $5762 and $5355, respectively. As for self-treatment expenditures, primary liver cancer and severe hepatitis B were the highest, estimated to be $206 and $191, respectively. Uninsured patients reported almost no self-treatment expenses. For insured patients, direct medical costs differed significantly among the six HBV-related conditions, with the highest spending being for severe hepatitis B ($10114. Clearly this disease has a major impact in terms of healthcare costs.
Direct medical cost of all HBV-related diseases (dollar/per annual average admission)
The study found that the direct nonmedical cost of acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer, was $100, $719, $416, $619, $536 and $745. Transportation costs were $83, $537, $113,$235, $230 and $494, respectively, and were higher for insured versus uninsured patients. Nutrition expenses were $16, $170, $302, 383, $303 and $251, respectively. There were no statistically significant differences in the direct nonmedical cost of HBV-related diseases among those who did not have insurance. However, direct nonmedical costs of those who had insurance were highest for patient’s primary liver cancer.
Impact of disease burden on a household
The direct economic burden of HBV-related diseases and their impact on a household were illustrated in Table . The direct cost of HBV-related diseases as a proportion of annual family income ranged from 30.72% for those with acute Hepatitis B to 297.85% for those with primary liver cancer. Even after reimbursement, the direct cost of patients who experienced severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, and primary liver cancer exceeded 40.00% of disposal household income. The economic burden was significantly different among the six diseases for insured patients.
The impact of disease burden on a household (dollar/per annual average admission)
Re-analyses after excluding the 45 uninsured patients
We re-ran the analyses after excluding the 45 uninsured patients since some of the conditions were either not represented (severe hepatitis B) or have very few patients (acute hepatitis B, compensated cirrhosis, primary liver cancer) among uninsured patients (Table ). In this analysis, costs were stratified by level of care since costs may differ between tertiary and secondary hospitals.
As shown in Table , the direct cost for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, and primary liver cancer in tertiary hospitals was $3135, $10834, $4380, $6022, $7107, and $10213 respectively. The direct cost for acute hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, and primary liver cancer in secondary hospitals was $1388, $5588, $19919, $6565, and $13268, respectively. The direct costs for acute hepatitis B were significantly higher in tertiary hospitals compared to secondary hospitals (x2
0.0378), whereas the opposite was true for those with chronic hepatitis B (x2
The direct cost of all HBV-related diseases stratified by hospitals (dollar/per average annual admission)
As shown in Table , median cost of patients with acute hepatitis B treated in secondary hospitals is significantly lower than those treated in tertiary hospitals (1388 vs. 3135, p
0.04). ). It should be noted, however, that the sample size of patients with acute hepatitis B treated in secondary hospitals is quite low (3 only) and the results on cost comparison may not be meaningful. For patients with chronic hepatitis B however, 64 were treated in secondary hospitals and 385 in tertiary hospitals. The median cost of those treated in secondary hospitals is significantly higher (5588 vs. 4380, p