Treating all those with hepatitis C virus (HCV) who are on Medicaid would save money and benefit the health and longevity of the population compared with the current system of restricting treatment to those with more advanced liver disease. Publishing their findings in the journal ScienceDirect, researchers used mathematical modeling to compare the two treatment strategies using hypothetical cohorts of 45- to 55 year-old Medicaid beneficiaries.
The cohorts did not include those with a history of decompensated cirrhosis, liver transplantation or coinfection with HIV.
The researchers presumed that everyone would be treated with either Harvoni (ledipasvir/sofosbuvir) or Viekira Pak (ombitasvir/paritaprevir/ritonavir; dasabuvir).
The analysis looked at lifetime costs and the cost to provide additional quality-adjusted life years (QALYs). A QALY is one year lived in good health. A year lived in more diminished health counts as less than one QALY year in proportion with the drop in overall health.
Compared with restricted treatment, providing treatment to all was less costly, by $5,369 to $11,960 per cohort analyzed and yielded 0.82 to 3.01 additional QALYs. For example, for a cohort of 50-year-olds, which represents the average Medicaid recipient living with HCV, restricted treatment cost $30,610 and provided 5.47 QALY, while treatment for all cost $21,410 and yielded 6.31 QALYs, for a difference of $9,200 and 0.84 QALYs.
The researchers estimated that providing full access to hep C treatment would avert 5,994 cases of hepatocellular carcinoma (HCC, the most common form of liver cancer) and 121 liver transplants per 100,000 Medicaid recipients with the virus.
“Collaboration between state and federal payers may be needed to realize the full public health impact of recent innovations in hepatitis C treatment,” the study authors concluded.
To read the study abstract, click here.