Open Access Open Badges Research article

Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China

Jingjing Lu12, Aiqiang Xu1, Jian Wang2*, Li Zhang1, Lizhi Song1, Renpeng Li1, Shunxiang Zhang3, Guihua Zhuang4 and Mingshan Lu5

Author Affiliations

1 Center for Health Management and Policy in Shandong University, Jinan, Shandong, 250012, China

2 Shandong Center for Disease Control and Prevention, Jinan, Shandong, 250014, China

3 Shenzhen Center for Disease Control and Prevention, Shenzhen, 51800, China

4 Department of Epidemiology and Biostatistics, Xi'an Jiaotong University College of Medicine, Xi’an, Shanxi, 710049, China

5 Department of Economics, University of Calgary, Calgary, Alberta, T2N4T4, Canada

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BMC Health Services Research 2013, 13:37  doi:10.1186/1472-6963-13-37

Published: 31 January 2013



Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease.


From April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China.


Our data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute hepatitis B) to 297.85% (for primary liver cancer) of the average annual household income in our sample. Even for patients with health insurance, direct out-of-pocket cost of all HBV-related diseases except acute hepatitis B exceeded 40.00% of the patient’s disposable household income, making it a catastrophic expenditure for the household.


Hepatitis B imposes considerable economic burden on a family. Our findings will help health policy makers’ understanding of the magnitude of the economic burden of HBV-related diseases in China. Evidence from our study also contributes to our understanding of potential benefits to society from allocating more resources to preventing and treating HBV infection, as well as increasing insurance coverage in China. These findings have important policy implications for health care reform efforts currently underway in China focusing on how to reduce the burden of catastrophic disease for its citizens.