Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection



Despite the high efficacy and safety associated with direct-acting antivirals (DAAs), access to HCV treatment has been frequently restricted because of the high DAA drug costs.


To (1) compare HCV treatment initiation rates between HCV monoinfected and HCV/HIV coinfected patients before (pre-DAA period) and after (post-DAA period) all-oral DAAs became available; and to (2) estimate the HCV treatment costs for payers and patients.

Research Design and Methods

A retrospective analysis of the MarketScan® Databases (2009–2016) was conducted for newly diagnosed HCV patients. Multivariable logistic regression was used to estimate the odds ratio (OR) of initiating HCV treatments during the pre-DAA and post-DAA periods. Kruskal–Wallis test was used to compare drug costs for dual, triple and all-oral therapies.


A total of 15,063 HCV patients [382 (2.5%) HIV coinfected] in the pre-DAA period and 14,896 [429 (2.9%) HIV coinfected] in the post-DAA period were included. HCV/HIV coinfected patients had lower odds of HCV treatment uptake compared to HCV monoinfected patients during the pre-DAA period [OR, 0.59; 95% confidence interval (CI), 0.45–0.78], but no significant difference in odds of HCV treatment uptake was observed during the post-DAA period (OR, 1.08; 95% CI, 0.87–1.33). From 2009 to 2016, average payers’ treatment costs (dual, $20,820; all-oral DAAs, $99,661; p < 0.001) as well as average patients’ copayments (dual, $593; all-oral DAAs $933; p < 0.001) increased significantly.


HCV treatment initiation rates increased, especially among HCV/HIV coinfected patients, from the pre-DAA to the post-DAA period. However, payers’ expenditures per course of therapy saw an almost fivefold increase and patients’ copayments increased by 55%.

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Fig. 1
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Antiretroviral therapy


Confidence intervals


Direct-acting antiviral agents


Healthcare Common Procedure Coding System


Hepatitis C virus


Human immunodeficiency virus


International Classification of Diseases


National Drug Code


Organisation for Economic Co-operation and Development


Odds ratio


(Pegylated) interferon




Standard deviation


Sustained virologic response


Veterans Health Administration


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Research reported in this publication was supported in part by the National Institute on Drug Abuse of the National Institutes of Health under Award No. K01DA045618 (to HP).

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Correspondence to Haesuk Park.

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See Tables 3, 4, 5, 6 and Figs. 5, 6, 7.

Table 3 Diagnosis codes of baseline comorbidities
Table 4 Total number of treatment initiations during the pre-DAA period (n = 15,063)
Table 5 Total number of treatment initiations during the post-DAA period (n = 14,896)
Table 6 Number, treatment duration, total payers’ cost, and total patients’ OOP cost per treatment regimen
Fig. 5

Study layout

Fig. 6

Choice of agents among patients who initiated all-oral therapies during the post-DAA period (n = 4775)

Fig. 7

Flowchart of treatment episodes included in cost analysis (n = 7407)

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van Boemmel-Wegmann, S., Lo Re, V. & Park, H. Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection. Dig Dis Sci 65, 3159–3174 (2020). https://doi.org/10.1007/s10620-019-06037-z

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  • Hepatitis C
  • HIV
  • Coinfection
  • Treatment initiation
  • Drug costs