The economic burden of hepatitis B in Germany.

Despite the widespread distribution of Hepatitis B virus (HBV) infection and the ongoing controversy about HBV immunization, surprisingly few published studies examined in detail the economic impact of HBV infection in Europe. Therefore, we investigated a cohort of 180 patients throughout Germany to evaluate the economic burden of HBV-associated disease. In 58 patients with acute and 122 patients with chronic HBV infection, cost-consuming events including direct medical costs and work-loss costs were documented. The direct costs were DM 7702 (95% confidence interval (CI): 5473-9931) for each acute HBV infection and DM 4247 (CI: 1601-6893) per patient-year of chronic HBV infection, with marked differences between different stages of HBV disease. The derived overall costs (1997 price levels) per year were DM 10,018 (CI: 7613-12,421) and DM 4860 (CI: 2185-7536), respectively. Based on crude population-based estimates (30,000 acute and 420,000 chronic HBV cases), we calculated the total HBV-related costs in Germany to exceed DM 1200 millions in 1997 (CI: 924.2-1536.7), with the treatment of patients with chronic active HBV disease as the major cost determinant. Previously published data from Germany probably overestimated the financial impact of acute HBV infection. In summary, our results illustrate the ongoing economic importance of this potentially life-threatening, but preventable disease and support the call for more accurate HBV surveillance and control in Germany.