OBJECTIVES

: Comprehensive, multi-stakeholder action toward Hepatitis C (HCV) elimination in the United States is required to meet the bold goals set by the World Health Organization and National Academies. In this research project, we aim to better understand the Medicaid-, Medicare-, and dual-eligible patients with HCV, while quantifying the expected incremental costs of infection and demonstrated costs of treatment.

METHODS

: To estimate the population of patients with HCV, Census Bureau data of insurance type and age were multiplied by published prevalence by age estimates. CDC’s published rates of disease progression were used to approximate the disease stages in the Medicare-, Medicaid-, and dual-insured HCV populations. To estimate the monthly costs of downstream complications, literature values for costs specific to disease stage and insurer were used. Medicaid and Medicare 2018 Drug Spending Dashboards (CMS) were analyzed to estimate the total reimbursement for common HCV treatment regimens. The estimation of the number of patients with HCV in each insurance population is a key limitation.

RESULTS

: The majority (56%) of patients with HCV fall within the 35-64-year age group and are primarily (72%) covered by Medicaid. We estimate monthly costs by disease stage: chronic infection (combined: $363,116,108), decompensated cirrhosis (combined: $64,324,418), and hepatocellular carcinoma (combined: $34,282,568). We estimate that Medicaid and Medicare spend about $165 million and $330 million, respectively, each month filling prescriptions for common HCV treatment regimens.

CONCLUSIONS

: HCV is entirely treatable, even curable, yet public spending toward treatment remains on par with spending toward downstream complications of untreated HCV infection. Medicare’s spending on HCV treatment outpaces Medicaid’s; future research could consider how treatment for Medicaid patients, possibly using Medicare resources, would impact HCV spending in the long-term, as more members with HCV, potentially with costly disease progression, age into Medicare. Future research could investigate policy recommendations for and financial implications of care coordination services.