Abstract
PurposeSafety-net health systems, which serve a disproportionate share of patients at high risk for hepatitis C virus (HCV) infection, may use revenue generated by the federal drug discount pricing program, known as 340B, to support multidisciplinary care. Budgetary impacts of repealing the drug-pricing program are unknown. Our objective was to conduct a budgetary impact analysis of a multidisciplinary primary care-based HCV treatment program, with and without 340B support.MethodsWe conducted a budgetary impact analysis from the perspective of a large safety-net medical center in Boston, Massachusetts. Participants included 302 HCV-infected patients (mean age 45, 75% male, 53% white, 77% Medicaid) referred to the primary care-based HCV treatment program from 2015–2016. Main measures included costs and revenues associated with the treatment program. Our main outcomes were net cost with and without 340B Drug Pricing support.ResultsTotal program costs were $942,770, while revenues totaled $1.2 million. With the 340B Drug Pricing Program the hospital received a net revenue of $930 per patient referred to the HCV treatment program. In the absence of the 340B program, the hospital would lose $370 per patient referred. Ninety-seven percent (68/70) of patients who initiated treatment in the program achieved a sustained virologic response (SVR) at a net cost of $4,150 each, among this patient subset.ConclusionsThe 340B Drug Pricing Program enabled a safety-net hospital to deliver effective primary care-based HCV treatment using a multidisciplinary care team. Efforts to sustain the 340B program could enable dissemination of similar HCV treatment models elsewhere.
Highlights
Hepatitis C virus (HCV) infection is a leading cause of morbidity and mortality in the United States [US], with prevalence estimates between 1–2% or 2.7–3.9 million individuals infected, [1] and in excess of 10,000 deaths annually.[2]
Among the 302 patients referred to the program, three-fourths were male, 53% were white, and the mean age was 45 years
Medicaid and Medicare patients comprised most of the observed payer mix, with Medicaid patients accounting for 77%, and Medicare 15%. (Table 1)
Summary
Hepatitis C virus (HCV) infection is a leading cause of morbidity and mortality in the United States [US], with prevalence estimates between 1–2% or 2.7–3.9 million individuals infected, [1] and in excess of 10,000 deaths annually.[2]. Gastroenterology or infectious diseases sub-specialty practices have treated HCV. Oral agents with improved efficacy and little toxicity enables HCV treatment in primary care settings.[5] Treating HCV in primary care is important for many reasons. Sub-specialty treatment capacity is limited in the US [6] and as a result, specialty practices may not be able to meet future demand for HCV treatment. Referral from primary to sub-specialty care is a well-documented point at which patients are lost to follow-up.[7] Treatment in primary care may offer an opportunity to addrsess this loss to follow-up among difficult to treat patients
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