Background. Data on the economic burden of chronic hepatitis C (CHC) among immigrants are limited. Our objective was to estimate the CHC-attributable mortality and healthcare costs among immigrants in Ontario, Canada. Methods. We conducted a population-based matched cohort study among immigrants diagnosed with CHC between May 31, 2003, and December 31, 2018, using linked health administrative data. Immigrants with CHC (exposed) were matched 1 : 1 to immigrants without CHC (unexposed) using a combination of hard (index date, sex, and age) and propensity-score matching. Net costs (2020 Canadian dollars) collected from the healthcare payer perspective were calculated using a phase-of-care approach and used to estimate long-term costs adjusted for survival. Results. We matched 5,575 exposed individuals with unexposed controls, achieving a balanced match. The mean age was 47 years, and 52% was male. On average, 10.5% of exposed and 3.5% of unexposed individuals died 15 years postindex (relative risk = 2.9; 95% confidence interval (CI): 2.6–3.5). The net 30-day costs per person were $88 (95% CI: 55 to 122) for the prediagnosis, $324 (95% CI: 291 to 356) for the initial phase, $1,016 (95% CI: 900 to 1,132) for the late phase, and $975 (95% CI: −25 to 1,974) for the terminal phase. The mean net healthcare cost adjusted for survival at 15 years was $90,448. Conclusions. Compared to unexposed immigrants, immigrants infected with CHC have higher mortality rates and greater healthcare costs. These findings will support the planning of HCV elimination efforts among key risk groups in the province.

中文翻译：

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移民中丙型肝炎可归因的医疗费用和死亡率：一项基于人群的匹配队列研究

背景。有关移民中慢性丙型肝炎 (CHC) 经济负担的数据有限。我们的目标是估算加拿大安大略省移民的 CHC 死亡率和医疗费用。方法。我们使用关联的健康管理数据，对 2003 年 5 月 31 日至 2018 年 12 月 31 日期间诊断患有 CHC 的移民进行了一项基于人群的匹配队列研究。使用硬匹配（索引日期、性别和年龄）和倾向得分匹配的组合，将患有 CHC（暴露）的移民与不患有 CHC（未暴露）的移民进行 1:1 匹配。从医疗保健付款人的角度收集的净成本（2020 加元）是使用阶段护理方法计算的，并用于估计根据生存调整的长期成本。结果。我们将 5,575 名暴露的个体与未暴露的对照进行匹配，实现了平衡匹配。平均年龄为 47 岁，其中 52% 为男性。平均而言，10.5% 的暴露者和 3.5% 的未暴露者在指数后 15 年内死亡（相对风险 = 2.9；95% 置信区间 (CI)：2.6–3.5）。预诊断的每人 30 天净费用为 88 美元（95% CI：55 至 122），初始阶段为 324 美元（95% CI：291 至 356），后续阶段为 1,016 美元（95% CI：900 至 1,132）。晚期阶段为 975 美元（95% CI：-25 至 1,974）。根据 15 年生存调整后的平均净医疗费用为 90,448 美元。结论。与未接触过的移民相比，感染 CHC 的移民死亡率更高，医疗费用也更高。这些发现将支持该省主要风险群体的丙肝消除工作规划。