Effective and efficient care delivery for HCV treatments in Medicaid

Abstract

ABSTRACTHepatitis C virus (HCV) was discovered 25 years ago [1,2], and there is a need to evaluate the efficient delivery of effective care, due to the distribution of the disease, in hard-to-reach subgroups, as well as increased treatment efficacy and costs. The predominant treatment regimen used in practice, peginterferon–ribavirin, has had only modest efficacy. Developed for over a decade, albeit expensive, ‘Direct Acting Antivirals (DAAs)’ have emerged with notable increases in effectiveness and less side effects in comparison to current treatment options. It is necessary to evaluate the efficient delivery of effective HCV treatments, to maximize value and health benefits achieved, and determine the most valued mix of HCV treatments.Objectives: The objective of the study was to evaluate the cost efficiency of American Association for the Study of Liver Diseases and Infectious Disease Society of America (AASLD-IDSA) recommended treatments for HCV patients with cirrhosis. Economic evaluation (cost–benefit analysis) was used to evaluate the cost and allocative efficiency of HCV treatment care delivery in the Medicaid population. This study modeled HCV-infected genotype 1a Medicaid beneficiaries with cirrhosis and AASLD-IDSA recommended treatments, in comparison to the prevailing options of interferon/ribavirin regimen and watch-and-wait/no-treatment strategy, over a 10-year time span. The study used data from the published literature as inputs in an economic evaluation model.Methods: Published literature and the Medicaid National Average Drug Acquisition Cost were used to analyze costs (treatment costs) and benefits (avoided medical costs).Results: For the Medicaid patient cohort with cirrhosis, relative to no-treatment, the health care savings for elbasvir–grazoprevir will be $21,667 per person over the next 10 years. Direct acting antivirals result in lower medical expenses than peginterferon–ribavirin and watch/wait regimens.Conclusions: This study shows the importance of treating patients early on in the disease process in order to reap savings for direct acting antivirals, and maintain cost-efficient delivery of HCV treatments.