OBJECTIVES: Delaying access to direct-acting antivirals (DAAs) among patients with hepatitis C virus (HCV) can increase the risk of liver-related complications and medical costs. We examined economic burden associated with sobriety restrictions (SR) for DAA access among Medicaid patients with HCV.

METHODS: We used the Anlitiks All Payor Claims data, an open-source data representing all state Medicaids (January 2020-June 2022). Patients initiating DAAs (i.e., index date) between January-December 2021 were categorized based on their “state of residence” on index date into States with no sobriety restrictions (S/no-SR) and States with sobriety restrictions (S/SR). All-cause and disease specific costs were examined among patients with ≥12 months pre-index, ≥6 months post-index, and continuous medical enrollment (i.e., ≥1 medical claim) during follow-up. We compared all-cause per-patient per month (PPPM) medical cost (e.g., inpatient, outpatient, ER, and office) and all-cause PPPM pharmacy costs between S/no-SR vs. S/SR.

RESULTS: Among patients in S/no-SR cohort (n=4,623), mean age was 43.0 (SD=11.51) years, 58.1% (n=2,686) male, and 59.68% (n=2,759) with substance use history. Among the S/SR cohort (n=2,295), mean age was 45.0 (SD=12.02) years, 50.28% (n=1,154) male, and 44.1% (n=1,012) with substance use history. PPPM all-cause medical costs were significantly lower (p<0.05) for S/no-SR vs. S/SR cohort for: inpatient [$3,441.04 vs. $5,680.10], outpatient [$42.66 vs. $83.60], ER [$97.86 vs. $155.73], and office [$65.74 vs. $80.11] visits. All-cause total medical PPPM costs for S/no-SR vs S/SR patients were $753.70 vs. $1,419.31 (p<0.05), HCV-specific cost patterns were similar. All-cause PPPM pharmacy cost was also significantly lower (p<0.05) for S/no-SR ($7,309.66) vs S/SR ($9,150.81).

CONCLUSIONS: In this analysis, patients initiating DAAs in S/no-SR had nearly 20% and 50% lower PPPM pharmacy and medical costs, respectively; lower medical costs driven by 40% fewer inpatient visits. Findings suggest that SR may increase medical costs potentially due to adverse long-term patient outcomes.