PMU15 A Budget Impact Analysis of Universal Hepatitis C Virus (HCV) Testing for Patients with Substance Use Disorders

Abstract

To estimate the budget impact of providing universal hepatitis C virus (HCV) testing and treatment in patients with substance use disorders (SUD) in the United States. We developed an interactive ten-year (2020-2029) budget impact model (BIM) to project the health and economic outcomes associated with HCV testing among patients with SUD from a payer perspective. We compared two strategies in terms of costs related to HCV testing, treatment, and liver-related outcomes: 1) current HCV testing rate (i.e., a testing rate of 18%) in the baseline year and followed by direct-acting antivirals (DAA) treatment; and 2) universal HCV testing rate (i.e., a testing rate of 100%) in the baseline year then followed by DAA treatment. DAA treatment receipt following a positive HCV test was stratified by baseline cirrhosis status. We explored sensitivity analyses around values for the BIM time horizon (5∼20 years), and proportion of patients with cirrhosis at baseline (5%∼20%). By 2029, universal HCV testing would save $30 billion ($183 per person) to the health care budget compared to the current scenario. In our twenty-year BIM, cost-savings from prevented liver-related complications ($17,977) would outweigh HCV testing and treatment costs ($12,369) by $5,608 per person for all populations with SUD. However, the five-year BIM would not achieve the cost-savings, adding $4,189 per person. Increases in the proportion of patients with cirrhosis from 5% to 20% would result in saving ranging from $606 to -$662 per person, indicating that screening patients with SUD for HCV earlier without cirrhosis saves more budget. Increasing HCV testing reduces liver-related costs, which outweighs the cost of HCV testing and treatment within a 10-year time horizon. Policymakers should consider the economic value in providing HCV testing and treatment early before patients with SUD and HCV developing costly advanced liver disease.