PerspectiveIn the Journals

Unrestricted access to HCV therapy cost-effective for Medicaid beneficiaries

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July 11, 2016

In a cost-effectiveness analysis, unrestricted access to treatment for patients with hepatitis C virus infection was more cost-effective compared with the current policy that restricts treatment to only those with advanced disease.

“Our cost-effectiveness analysis revealed that for current Medicaid beneficiaries, the increased short-term costs of unrestricted access to care can be offset by savings from reduced complications in 9 [to] 16 years, depending on the treatment strategy and age of the cohort,” Alexis P. Chidi, PhD, MSPH, of the University of Pittsburgh School of Medicine, said in a press release.

Alexis P. Chidi, PhD, MSPH

Alexis P. Chidi

The researchers used a Markov model to compare two strategies for Medicaid beneficiaries aged between 45 and 55 years: current practice, where only advanced disease is treated before Medicare eligibility, and full access, which includes both early-stage and advanced disease treated before Medicare eligibility.

“We calculated the incremental cost-effectiveness ratio and compared the costs and public health effects of each strategy from the perspective of Medicare alone as well as the Centers for Medicare and Medicaid Services perspective,” the researchers wrote. “We varied model inputs in one-way and probabilistic sensitivity analyses.”

Results of a base-case analysis showed that full access was more cost-effective compared with current practice for all cohorts and perspectives. The differences in cost ranged from $5,369 to $11,960 and effectiveness ranged from 0.82 to 3.01 quality-adjusted life years (QALYs).

For the average Medicaid patient with HCV (50-year-old cohort), the current practice strategy cost an additional $9,200 per patient and yielded 0.84 fewer QALYs compared with the full-access strategy ($21,410; 6.31 QALYs).

From the CMS perspective, the full-access strategy yielded cost savings for each cohort, but to a lesser degree, the researchers said. Compared with the full-access strategy ($90.524; 15.79 QALYs), the current practice strategy cost an additional $8,003 per patient and yielded 2.73 fewer QALYs ($98,527; 13.06 QALYs) for the cohort of 50-year-olds. The full-access strategy was more cost-saving for younger cohorts from the CMS perspective, the researchers wrote.

In a probabilistic sensitivity analysis, full access was cost saving in 93% of model iterations. Compared with current practice, full access averted 5,994 cases of hepatocellular carcinoma and 121 liver transplants per 100,000 patients.

The researchers acknowledged the following limitations of their study: analytic methods may provide better estimates, the study estimated treatment efficacy which could overestimate treatment effectiveness in the real-world, their model only included liver-related costs and not other potential increases in health care costs associated with reduced early mortality, among others.

The researchers concluded: “This study … highlights that in a multipayer health care system, efforts to minimize costs for individual payers can result in cost shifting and economic efficiency for the system as a whole. In light of this, collaborative efforts between state and federal payers may be needed to realize the full public health impact of recent advances in hepatitis C therapy.” – by Melinda Stevens

Disclosure: Chidi reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

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PERSPECTIVE
Naim Alkhouri

Naim Alkhouri

Although the hepatitis C treatment landscape has been revolutionized by the introduction of highly-effective direct-acting antivirals, one of the biggest frustrations that we face in treating these patients is the lack of insurance coverage due to the high-cost of these drugs.  HCV is a progressive disease that can lead to the development of cirrhosis, liver cancer and multiple extra-hepatic manifestations. 

The new antivirals can cure HCV in as little as 8 weeks, and this duration is likely to get shorter with future antivirals. Unfortunately, Medicaid has restricted access to the new antivirals for only patients with the most advanced form of HCV (those with stage 3 and 4 fibrosis). In the current study, by using statistical modeling, the authors demonstrated clearly that a policy that offers HCV treatment to all infected patients is more cost-effective than the current Medicaid policy. These findings should provide health care policy makers with the information needed to expand coverage to all patients regardless of disease severity.


Naim Alkhouri, MD
Staff physician
Medical director of the Metabolic Liver Disease Clinic
Digestive Disease Institute
Cleveland Clinic

Disclosure: Alkhouri reports no relevant financial disclosures.