Undiagnosed Hereditary Hemochromatosis Costs Health Care System Million
Posted April 26th, 2016 by Canadian Hemochromatosis Society
Canada’s health care system could save many millions of dollars each year if every Canadian with hereditary hemochromatosis (HHC) was diagnosed and treated, according to a position paper just released by the Canadian Hemochromatosis Society. HCC, Canada’s most common genetic disorder, causes the body to store excess iron in various unintended parts of the body, including the liver, heart, pancreas and joints. Left untreated, this overload of iron can have devastating consequences.
The paper entitled “The Economic Burden of Undiagnosed Hereditary Hemochromatosis” was prepared by Dr. Sam Krikler, a Hematopathologist who is the Director of the Department of Laboratory Medicine at Surrey Memorial Hospital and an Associate Clinical Professor in the Department of Pathology and Laboratory Medicine at the University of British Columbia. Dr. Krikler is also the Chair of the Canadian Hemochromatosis Society’s Medical Advisory Board. The paper states that the prevalence of the most “common” (C282Y) form of HHC is approximately 3 per 1,000 in Canadians of Northern European heritage. Large population studies have shown that 70 percent of affected individuals will load iron and 10 percent of these will develop severe complications of iron overload, including diabetes, arthritis, cirrhosis and hepatocellular carcinoma (primary liver cancer). The latter two conditions are the most serious complications of untreated HHC and are responsible for the highest direct costs to the health care system; and general societal costs for lost economic productivity. Based on the above statistic, it is estimated that approximately 80,000 people in Canada are at risk of developing HHC. Early diagnosis (by iron chemistry tests and the confirmatory genetic test) and treatment by phlebotomy (blood-letting) prevents these serious diseases which rob people of their health and also add avoidable expenses to the health-care system.
A recent comprehensive report prepared by the Canadian Liver Foundation points out the economic impact of liver disease in this country. According to the report, average annual costs for inpatient diagnostic and therapeutic procedures alone (e.g. endoscopy and paracentesis) for liver disease amount to $50 million. This does not include costs related to hospitalization (nursing care, drugs, laboratory tests and imaging studies). Out-patient costs (doctors visits, etc.) must also be considered. The societal cost for lost productivity and the toll borne by care-givers cannot be ignored. Based on a conservative assumption that approximately 5% of cirrhosis and liver cancer is caused by undiagnosed HHC, the total cost runs into many millions of dollars. Two other common diseases associated with HHC add multiples to any base amount attributable to the condition. It is estimated that 30% people with HHC will develop some form of arthritis and that two percent of insulin resistant type-2 diabetics have HHC.
The paper concludes that there is a strong business case to allocate resources for the early diagnosis and treatment of HHC in addition to the ethical imperative to prevent and minimize suffering which is the raison-d’être of the Canadian Hemochromatosis Society.