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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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
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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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
- Hepatitis C
- Treatment initiation
- Drug costs