PIN42 THE IMPACT OF DIGITAL MEDICINE PROGRAM ON ECONOMIC AND PUBLIC HEALTH BENEFITS FOR HCV COVERAGE EXPANSION FROM A STATE MEDICAID PERSPECTIVE

Abstract

Direct-acting antiviral agents (DAAs) are highly effective, yet costly cures for hepatitis C virus (HCV) infection. Many Medicaid programs have restrictions using liver fibrosis stages, alcohol use, or prescriber restrictions. A novel digital medicine program (DMP), consisting of digital medicines (ledipasvir/sofosbuvir or sofosbuvir/velpatasvir packaged with ingestible sensors), a small wearable sensor patch, and a mobile application, has shown >97% ingestion adherence rates and >99% sustained virological response at 12 weeks post-treatment in real-world HCV studies. This study estimated the economic and public health impact of the DMP when Medicaid programs with current limited treatment access are expanded to full access. We used the Medicaid epidemiology data as a base for percentage of patients with access to HCV treatment. A cost-comparison analysis was conducted to estimate the per-patient-per-month (PPPM) savings associated with DAA+DMP in comparison with DAA alone. Combined with annual disease transition probabilities and cost for each disease state obtained from published literature, a Markov model was developed to assess the economic and public health impact in two scenarios for 1,000 hypothetical Medicaid HCV patients under: 1) current limited access, 2) full access with DMP. Annual and cumulative costs, and the numbers of progressed disease states avoided were calculated. Even with the current access restrictions, the use of DAA+DMP yielded total savings of $2,043 PPPM compared to DDAs alone, which would allow additional treatment coverage of 24% patients annually. By granting full access and with DMP, Medicaid can achieve cost-savings within 4 years, and prevent progression of 57 decompensated cirrhosis, 76 hepatocellular carcinoma cases and 4 liver transplants by Year 5 for every 1,000 HCV patients. The DAA+DMP provides significant savings in treating HCV compared to DAAs alone. Full access to HCV therapy for Medicaid patients with use of DMP can be economically beneficial, while preventing life-threatening complications.