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Cost-effectiveness of Total State Coverage for Hepatitis C Medications
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the actual costs for the DAAs are often much less than prices used in this study being in reality as low as $15,000 per regimen so with proper negotiations cost-effectiveness is much greater than this study reports
study says "Costs of DAA treatment were based on the wholesale acquisition price of glecaprevir/pibrentasvir (Mavyret; AbbVie): $26,400 to $39,600 for an 8- to 12-week treatment course (Table 1 [part A and part B]1,4,7,12,15,18-32). This cost represents the latest DAA treatment available on the market at the lowest available cost that Medicaid would most likely approve."
May 20, 2021
Expanded coverage under a Medicare-Medicaid partnership to treat all prevalent cases of hepatitis C appears to be cost-effective by saving money and improving patient outcomes.
Most Medicaid beneficiaries with hepatitis C virus (HCV) are not treated with direct-acting agents because of budget constraints, but they experience costly complications after becoming Medicare eligible. Maryland's "total coverage" proposal could receive a credit from Medicare to offset Medicaid investments in treatments that could lead to Medicare savings. This study analyzes the cost-effectiveness and budget impact of total coverage for HCV treatments sponsored by state Medicare and Medicaid.
Study Design: A Markov model simulated patients going through the care continuum of HCV. The model simulated 3 pathways: standard coverage with a 50% probability of screening for HCV and 20% probability of treatment; risk-stratified total coverage with assumed 80% probability of screening and 60% treatment rate; and total coverage with assumed 80% probability of screening and 100% treatment rate.
Methods: The model calculated US$ and quality-adjusted life-years (QALYs) to produce an incremental cost-effectiveness ratio evaluated at a willingness-to-pay threshold of $100,000/QALY. The budget impact for the state of Maryland was calculated in terms of per member per year.
Results: Total coverage and risk-stratified coverage saved $158 per patient and $178 per patient, respectively, compared with standard care at an increased effectiveness of 0.05 and 0.02 QALYs over 25 years. Total coverage and risk-stratified total coverage would save $1.0 billion and $1.1 billion, respectively, after 25 years.
Conclusions: Medicare-Medicaid partnerships to pay for all HCV treatments today represent good value and a low budget impact. States with trouble covering HCV treatments should consider using this model to plan coverage decisions.
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