Hepatitis C Elimination via Subscription-Based Payment Models: A Synthetic Control Study from Washington and Louisiana
Author(s)
Zizi Elsisi, BSc, MS1, Jing Li, MA, PhD1, Nina Kim, BA, MSc, MD2, Anirban Basu, PhD1;
1The Comparative Health Outcomes, Policy, and Economics (CHOICE) institute, University of Washington, Seattle, WA, USA, 2Department of Medicine, Division of Allergy & Infectious diseases, Department of Health services and population health University of Washington, Seattle, WA, USA
1The Comparative Health Outcomes, Policy, and Economics (CHOICE) institute, University of Washington, Seattle, WA, USA, 2Department of Medicine, Division of Allergy & Infectious diseases, Department of Health services and population health University of Washington, Seattle, WA, USA
OBJECTIVES: Despite the availability of effective direct-acting antivirals (DAAs), Hepatitis C virus (HCV) continues to affect 2.8 million Americans, with elimination goals remaining unmet. In 2019, Washington and Louisiana introduced a Subscription-Based Payment Model (SBPM) to enhance treatment affordability and accessibility. This study examined the impact of SBPM on HCV screening and treatment outcomes.
METHODS: Using data from Managed Medicaid enrollees aged 18-64 using the Komodo claims database (2018-2022), we evaluated the LA and WA policies against matched synthetic controls. These controls were developed by weighting 14 control states with similar Managed Medicaid policies, fibrosis and sobriety restrictions using patient-level factors (e.g., age, gender), state-level characteristics (e.g., poverty levels, physician density), and pre-treatment trends. Key outcomes included HCV and RNA screening rates (per 100,000 enrollees per month) and DAA initiation and refill rates (per 1,000 HCV-diagnosed patients per month). We used permutation tests to determine statistical significance (α = 0.1).
RESULTS: In Louisiana, SBPM significantly increased RNA testing by 35.19 per 100,000 enrollees/month and improved DAA initiation and refill by 7.77 and 24.38 per 1,000 patients/month, respectively. Total HCV screening showed no significant change (104.61 per 100,000 enrollees/month). In Washington, RNA testing (-11.88 per 100,000 enrollees/month) and HCV screening (-127.87 per 100,000 enrollees/month) declined compared to synthetic controls, but not significantly. However, Washington experienced a significant drop in DAA refill (-12.86 per 1,000 patients/month). DAA initiation showed no significant change in the first six months (-1.87 per 1,000 patients/month) but declined significantly after this period (-3.58 per 1,000 patients/month).
CONCLUSIONS: Louisiana’s SBPM improved HCV outcomes, demonstrating its potential to address treatment barriers. Washington’s mixed results highlight the importance of contextual factors, and further study in levels of patient engagement, provider inertia, and program design will be useful. These findings provide guidance for optimizing SBPMs to support national HCV elimination efforts.
METHODS: Using data from Managed Medicaid enrollees aged 18-64 using the Komodo claims database (2018-2022), we evaluated the LA and WA policies against matched synthetic controls. These controls were developed by weighting 14 control states with similar Managed Medicaid policies, fibrosis and sobriety restrictions using patient-level factors (e.g., age, gender), state-level characteristics (e.g., poverty levels, physician density), and pre-treatment trends. Key outcomes included HCV and RNA screening rates (per 100,000 enrollees per month) and DAA initiation and refill rates (per 1,000 HCV-diagnosed patients per month). We used permutation tests to determine statistical significance (α = 0.1).
RESULTS: In Louisiana, SBPM significantly increased RNA testing by 35.19 per 100,000 enrollees/month and improved DAA initiation and refill by 7.77 and 24.38 per 1,000 patients/month, respectively. Total HCV screening showed no significant change (104.61 per 100,000 enrollees/month). In Washington, RNA testing (-11.88 per 100,000 enrollees/month) and HCV screening (-127.87 per 100,000 enrollees/month) declined compared to synthetic controls, but not significantly. However, Washington experienced a significant drop in DAA refill (-12.86 per 1,000 patients/month). DAA initiation showed no significant change in the first six months (-1.87 per 1,000 patients/month) but declined significantly after this period (-3.58 per 1,000 patients/month).
CONCLUSIONS: Louisiana’s SBPM improved HCV outcomes, demonstrating its potential to address treatment barriers. Washington’s mixed results highlight the importance of contextual factors, and further study in levels of patient engagement, provider inertia, and program design will be useful. These findings provide guidance for optimizing SBPMs to support national HCV elimination efforts.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR134
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
SDC: Gastrointestinal Disorders, SDC: Infectious Disease (non-vaccine)