The Costs of Hepatitis C by Liver Disease Stage: Estimates from the Veterans Health Administration
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The release of highly effective but costly medications for the treatment of hepatitis C virus combined with a doubling in the incidence of hepatitis C virus have posed substantial financial challenges for many healthcare systems. We provide estimates of the cost of treating patients with hepatitis C virus that can inform the triage of pharmaceutical care in systems with limited healthcare resources.
We conducted an observational study using a national US cohort of 206,090 veterans with laboratory-identified hepatitis C virus followed from Fiscal Year 2010 to 2014. We estimated the cost of: non-advanced Fibrosis-4; advanced Fibrosis-4; hepatocellular carcinoma; liver transplant; and post-liver transplant. The former two stages were ascertained using laboratory result data; the latter stages were ascertained using administrative data. Costs were obtained from the Veterans Health Administration’s activity-based cost accounting system and more closely represent the actual costs of providing care, an improvement on the charge data that generally characterizes the hepatitis C virus cost literature. Generalized estimating equations were used to estimate and predict costs per liver disease stage. Missing data were multiply imputed.
Annual costs of care increased as patients progressed from non-advanced Fibrosis-4 to advanced Fibrosis-4, hepatocellular carcinoma, and liver transplant (all p < 0.001). Post-liver transplant, costs decreased significantly (p < 0.001). In simulations, patients were estimated to incur the following annual costs: US $17,556 for non-advanced Fibrosis-4; US $20,791 for advanced Fibrosis-4; US $46,089 for liver cancer; US $261,959 in the year of the liver transplant; and US $18,643 per year after the liver transplant.
Cost differences of treating non-advanced and advanced Fibrosis-4 are relatively small. The greatest cost savings would be realized from avoiding progression to liver cancer and transplant.
RGM contributed to the study design, data interpretation, and writing of the manuscript, and is the overall guarantor of this work. PB contributed to the study conceptualization and design, data interpretation, and writing of the manuscript. JL contributed to the data acquisition and analyses, and writing of the manuscript. DO contributed to the funding, study conceptualization, and data interpretation. SA and JGF contributed to the data interpretation.
Compliance with Ethical Standards
This work was supported by Merit Review Award no. I01 HX000889-1A1 from the US Department of Veterans Affairs Health Services Research and Development Program. Jeremy D. Goldhaber-Fiebert was supported by Grant R01 DA15612-016 from the National Institutes of Health and the National Institute on Aging Career Development Award K01 AG037593-01A1. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Conflict of interest
Risha Gidwani-Marszowski, Douglas K. Owens, Jeanie Lo, Jeremy D. Goldhaber-Fiebert, Steven M. Asch, and Paul G. Barnett have no conflicts of interest that are directly relevant to the content of this article.
The datasets generated during and/or analyzed during the current study are not publicly available because of Veterans Health Administration regulations. Persons who are not approved by the project’s institutional review board are prohibited by the Veterans Health Administration from viewing the underlying data. Additionally, the Veterans Health Administration requires all its data to remain on its own secure servers.
- 11.Sofosbuvir (Sovaldi) for chronic hepatitis C. Med Lett Drugs Ther. 2014;56(1434):5–6.Google Scholar
- 12.Demko P, Dickson V. Insurers brace for high-cost Sovaldi. Mod Healthc. 2014;44(18):9.Google Scholar
- 13.Barlas S. States try to control medicaid pharmaceutical costs: numerous, diverse cost pressures force myriad reform efforts. Pharm Ther. 2015;40(4):260–2.Google Scholar
- 14.Millman J. An $84,000 hepatitis drug is giving states and insurers a major headache. Wonkblog. The Washington Post; Apr 28, 2014.Google Scholar
- 15.Neuman T, Hoadley J, Cubanski J. The cost of a cure: Medicare’s role in treating hepatitis C. 2014. Health Affairs Blog. Project HOPE: The People-to-People Health Foundation, Inc; Jun 5, 2014.Google Scholar
- 16.Somashekhar S. Costly hepatitis drug Sovaldi rattles industry. The Washington Post: Health & Science; Mar 1, 2014.Google Scholar
- 17.Knox R. Medicare struggling with hepatitis-C cure costs. Kaiser Health News; May 12, 2014.Google Scholar
- 23.HCV Guidance: Recommendations for testing, managing, and treating hepatitis C. When and in whom to initiate HCV therapy. The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. Jul 6, 2016. https://www.hcvguidelines.org/evaluate/when-whom.
- 28.McAdam-Marx C, McGarry LJ, Hane CA, Biskupiak J, Deniz B, Brixner DI. All-cause and incremental per patient per year cost associated with chronic hepatitis C virus and associated liver complications in the United States: a managed care perspective. J Manag Care Pharm. 2011;17(7):531–46.PubMedGoogle Scholar
- 45.Graham J. Medicaid, private insurers begin to lift curbs on pricey hepatitis C drugs. Kaiser Family Foundation. Kaiser Health News; Jul 5, 2016.Google Scholar