Medicaid policies that only offer hepatitis C treatment to patients with advanced disease may be more costly and less effective than an unrestricted, full-access approach, according to a recent study.
In most cases, if a Medicaid patient isn't yet eligible for Medicare, hepatitis C treatment is only available to them If they're in advanced stages of the disease. The International Society for Pharmacoeconomics and Outcomes Research published research on Monday that suggests that treating both early-stage and advanced disease can add 0.82 to 3.01 quality-adjusted years to a beneficiary's life and avert 5,994 hepatocelluar carcinoma (liver cancer) cases and 121 liver transplants per 100,000 patients.
The study, which tested its hypothesis among patients ages 45 to 55 using a mathematical model, found expanding access cost $5,369 to $11,960 more per patient.
Though expanding access would cost state Medicaid agencies more in the short term, treating early-stage patients could see better outcomes within nine to 16 years after implementation, depending on the treatment strategy and the age of the patient cohort, study author Alexis Chidi, a post-doctoral student at the University of Pittsburgh School of Medicine, said in a statement.
Harvoni and Viekira Pak “are more than 94% effective in as few as eight weeks for many patient subgroups, but most state Medicaid programs restrict their use due to cost,” Chidi said.
Hepatitis C affects 3.2 million people in the U.S. Models showed that 13-16 years after expanding access, $10,340 was saved per patient among 45-year-olds, $8,148 per patient among 50-year-olds and $5,695 per patient among 55-year-olds. Even in the worst-case scenario, a full-access strategy saved $3,197 to $3,568 per patient when treating 30,000 patients a year among 600,000 hepatitis C patients.
Treatments have made news for their breakthroughs in effectiveness but also for their extremely high costs, which have made the treatment prohibitive for some patients. Gilead Sciences' Harvoni, the costliest hepatitis C drug and one of the most expensive drugs on the market, can cost as much as $94,500 for a 12-week treatment, or about $1,125 per pill.
The study's authors did note that a study that takes into account resource constraints at state Medicaid agencies could provide more precise estimates, and the study doesn't take into account that some Medicaid managed-care plans may receive smaller drug discounts than those mandated by the Medicaid drug-rebate program. Additionally, the study estimated treatment efficacy using clinical trial data, which may overestimate real-world effectiveness. The model used in the study, which only included liver-related costs, also doesn't account for potential increases in cumulative healthcare costs associated with patients living longer lives.
The study was published in the June 2016 issue of Value in Health, the flagship journal of the International Society for Pharmacoeconomics and Outcomes Research.
