OBJECTIVES : The new Direct Antiviral Agents (DAAs) to treat hepatitis C virus (HCV) are innovative but very expensive. Scarce real-world evidence exists on how much new DAAs reduce downstream service spending and improve health outcomes. We examined the effects of new DAAs on other service use/spending and patient outcomes in Medicare, the federal health insurance program for the elderly and disabled in the US.

METHODS : The study population was Medicare beneficiaries with chronic hepatitis C between 2014 and 2016. The outcomes were hospitalizations, total health care spending, and death. We used ICD-9 or ICD-10 codes from Medicare claims data to identify HCV patients and construct hospitalizations/spending related to HCV and liver conditions. We obtained information on patient mortality from Medicare beneficiary files. We compared the outcomes in two ways: 1) between new DAA users and non-users; and 2) between those who completed therapy and those who did not after initiating one of the new DAAs. We followed patients up to 30 months from the date of HCV diagnosis for the first analysis, and from the last date of drug use for the second analysis. We used propensity score matching based on a comprehensive set of patient characteristics.

RESULTS : New DAA users had 2.3 percentage point lower mortality during the follow-up period (p<0.01). We found no significant differences in hospital admissions between users and non-users. Patients who completed new DAA therapy had 6 percentage point lower mortality than incompleters during the follow-up period (p<0.01). Among those who survived, completing DAA therapy did not reduce hospitalizations or health care spending.

CONCLUSIONS : New DAAs prevented adverse health outcomes among chronic HCV patients who were at imminent risk of dying. Continuing assessment is needed to identify patient sub-groups that are most cost-effective (lowest costs needed to avert one death) to treat with new DAAs.