Using a treat-all strategy for hepatitis C virus (HCV) among the U.S. Medicaid population would result in far higher cure rates, substantial reductions in severe liver disease complications and considerable cost savings across the country, according to a new analysis published in The American Journal of Managed Care.
The report further fuels the argument that several states’ policies to restrict hepatitis C treatment to only the sickest patients is not only unethical but also a major drain on the nation’s health care resources.
For the study, researchers in Virginia, California, New York and Michigan used a decision-analytic Markov model to follow the medical data of 120,980 treatment-naive patients with genotype 1 of chronic hepatitis C over their lifetime. Patients entered into the study were insured under Medicaid and were either treated under state-specific restrictions, which depended on their Metavir liver fibrosis scores, enrolled in a treat-all patient model or untreated.
All subjects were treated with Gilead’s all-oral treatment regimen Harvoni (ledipasvir/sofosbuvir) for 8 or 12 weeks depending on their cirrhosis scores, viral loads and other state-specific restrictions. Untreated patients at the end of the study were assumed to have aged into Medicare at 65 years, granting them access to treatment without restrictions.
Study authors found that the sustained virologic response (SVR) rate under restrictive Medicaid policies was 75.2 percent, compared with 95.9 percent of patients enrolled in the treat-all approach. Treating all eligible Medicaid patients for hepatitis C was also estimated to result in 36,752 fewer cases of cirrhosis, 1,739 fewer liver transplants and 8,169 fewer cases of hepatocellular carcinoma, the most common form of HCV-related liver cancer.
What’s more, researchers found that treating all Medicaid patients with chronic HCV resulted in a 39.4 percent savings, or nearly $3.8 billion dollars, and a decrease in the proportion of total costs attributable to downstream costs of care for viral liver disease.
The report concludes by calling for the reassessment of current restrictive state policies regarding HCV treatment in Medicaid populations in light of the data. Currently, 16 states across the United States limit hepatitis C treatment, purportedly in order to avoid the financial burden.