Cost-analysis of different management policies for patients with mild hepatitis A virus infection in Kazakhstan

OBJECTIVE For patients with mild hepatitis A virus (HAV) infection, this study compared estimates of total costs associated with managing cases under a policy of mandatory hospitalization in the Republic of Kazakhstan and estimates of total costs associated with managing cases in outpatient settings. Costs were estimated both from the perspective of the Ministry of Health and from a broader societal perspective. METHODS Data were collected by using a standardized structured questionnaire. For cases of mild HAV infection, medical records were obtained from 200 patients managed by hospitalization and from 251 patients managed in an outpatient setting. Personal interviews were also conducted to collect information on productivity losses and out-of-pocket expenses. RESULTS Nationally, we estimated about 21,600 cases of mild HAV infection annually. The mean annual treatment costs in hospital for mild HAV infection was estimated at 3.39 million US dollars (2001 US dollars) (95% confidence interval [CI] = [3.26 million US dollars-3.52 million US dollars]). The total annual mild HAV infection cost to the society, including direct medical and nonmedical costs and productivity losses due to 721,440 lost work days, was estimated at 6.26 million US dollars (95% CI [6.05 million US dollars-6.47 million US dollars]). In sensitivity analyses, the total annual cost of mild HAV infection ranged from 4.37 million US dollars to 24.66 million US dollars. The survey results showed that a relatively minor change in the current policy of mandatory hospitalization could result in an estimated total annual savings of 4.62 million US dollars (2001 US dollars) in Kazakhstan. CONCLUSION Adoption of an outpatient management policy for cases of mild HAV infection would generate substantial cost savings to the Ministry of Health and society.