Hepatitis C virus (HCV) infection has received significant attention in recent years due to the ability for near universal cure, the price of therapy, and increasing incidence due to injection drug use. While the discussion largely focuses on HCV infection in adults, children with HCV are a consistent minority of patients with long-term adverse outcomes of HCV. Few studies have defined the health care utilization of HCV-infected children.
Objective: To define trends in pediatric HCV cases and health care utilization using a national administrative database
The Pediatric Health Information Systems (PHIS) database contains inpatient encounter-level data from tertiary care pediatric hospitals in the United States. We identified pediatric HCV cases using validated ICD-9/ICD-10 diagnosis codes (070.41, 070.44, 070.51, 070.54, 070.70, 070.71, V0262, B18.2). We evaluated total cases identified, year of presentation, patient age, geographic location by state, aggregate cost of providing care and HIV-coinfection (ICD-9 code 042/ICD-10 code B20).
Results: Since 1992, there were 2175 unique pediatric patients identified with HCV infection. Case rates were highest in patients 15-17 yrs with a peak of 24 cases/10,000 admissions that fell to 10 cases /10,000 in 2000 and a low of 1 case/10,000 in 2015. Alarmingly, the rate in this group was back over 2 cases/10,000 in 2016 and 2017. HCV case rates in children 11-14 were the 2nd highest with more sustained peak from 1992-2006 and no precipitous decline. There were 49 patients with HIV co-infection, with rates highest prior to 1998 (range of 6.5-18%), but since 2002 have been <2% until 2017 (2.5%). For inpatient costs, 10% of HCV infected children accounted for 75% of the total cost of care. In 2004-2006, total charges for 329 HCV-infected children were just over $23 million, compared to 2015-2017 when total charges for 247 HCV-infected children were $21.8 million. Comparing these two eras and adjusting for inflation, there was a 3% decline in charges per patient.
While the burden of inpatient HCV in children has declined since the peak in the early 1990’s, there are worrisome increases detected in the last few years. A small minority of patients represent a disproportional amount of the total care provided. Early treatment of children would still likely prove cost-effective.
B. R. Lee,
R. Jhaveri, Abbvie: Investigator , Research support . Gilead: Investigator , Research support . Merck: Grant Investigator , Grant recipient .