Current Medicaid policies restrict treatment to people with advanced hepatitis C. But what would costs be like if there was unrestricted access to medications that have proven to cure the disease?
Interferon therapy was the standard treatment for hepatitis C until the introduction of the first generation of direct-acting antivirals, followed by the NS3/N4A oral protease inhibitors and others. Interferon was a suboptimal therapy in several ways, especially because it is associated with severe side effects. There are a range of interferon-free treatments available on the market now, but the price tags present a challenge for some patients.
Patients with hepatitis C are at high risk of developing cirrhosis, progressive fibrosis, or hepatocellular carcinoma. They may also need transplantation or even die from complications of the disease, but treatment helps reduce morbidity.
Current Medicaid policies restrict treatment to people with advanced hepatitis C. But what would costs be like if there were unrestricted access to medications that have proven to cure the disease? Researchers from the University of Pittsburgh compared outcomes associated with both kinds of policies.
Using Medicaid beneficiaries ages 45 to 55, the team evaluated the two strategies:
1. Current Practice: Only advanced disease is treated before Medicare eligibility
2. Full Access: Both early-stage and advanced disease are treated before Medicare eligibility
“We calculated the incremental cost-effectiveness ratio and compared the costs and public health effects of each strategy from the perspective of Medicare alone as well as the Centers for Medicare & Medicaid Services perspective,” first author Alexis Chidi, PhD, MSPH, and colleagues explained in the journal Value in Health.
So which method proved to be better?
Not only was Full Access less costly, but it was also more effective than Current Practice. The prices were $5,369 and $11,960, respectively, and Full Access resulted in cost saving in 93% of model iterations. Effectiveness was based on quality-adjusted life-years, which turned out to be 0.82 and 3.01, respectively. In addition, Full Access helped prevent 5,994 hepatocellular carcinoma cases and 121 liver transplants for every 100,000 patients when compared to Current Practice.
Based on this data, it’s apparent that restricting hepatitis C treatment to those with advanced disease results in higher costs and less effectiveness. Therefore, the researchers say that state and federal payers may need to consider the public health impact that Full Access care could make on the population.
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