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

Abstract

Background

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.

Objectives

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.

Results

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.

Conclusions

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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Abbreviations

ART:

Antiretroviral therapy

CI:

Confidence intervals

DAAs:

Direct-acting antiviral agents

HCPCS:

Healthcare Common Procedure Coding System

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

ICD:

International Classification of Diseases

NDC:

National Drug Code

OECD:

Organisation for Economic Co-operation and Development

OR:

Odds ratio

pegIFN:

(Pegylated) interferon

RBV:

Ribavirin

SD:

Standard deviation

SVR:

Sustained virologic response

VHA:

Veterans Health Administration

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Acknowledgment

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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Appendix

Appendix

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
figure5

Study layout

Fig. 6
figure6

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

Fig. 7
figure7

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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Keywords

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