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Lifetime medical costs of chronic hepatitis C in the United States: high cost burden for untreated HCV
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authors: CDC
Applied to a hypothetical cohort of adults with hepatitis C in 2020 using the low hepatitis C prevalence estimate of 2,228,000 adults, the overall medical cost burden was $200 billion (treated) compared to $347 billion (untreated). However, if the hepatitis C prevalence was as high as 4,043,200 adults, the overall medical cost burden was $364 billion (treated) and $630 billion (untreated). Our estimates suggest that if the hepatitis C 2020 prevalent population were treated, $146 billion to $266 billion in discounted lifetime medical costs might be averted compared with if none of the prevalent population received curative treatment: a cost savings of approximately $65,841 per person.
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Abstract
Background
More than 2.4 million people were estimated to have chronic hepatitis C (CHC) in the United States from 2017 to 2020. Direct-acting antiviral (DAA) therapy can cure hepatitis C and limit its complications, including liver cirrhosis and hepatocellular carcinoma (HCC). This study aims to estimate the lifetime medical cost burden of CHC in the United States.
Methods
We estimated the lifetime direct medical costs of CHC by disease stage, using medical and laboratory claims data and a Markov transition model. The analysis considered the cost of CHC separately for persons treated with DAAs and untreated persons. We estimated the cost of health care utilization associated with CHC per person for the initial year, remaining life years, and overall lifetimes and used these costs to estimate lifetime costs for the 2020 cohort of adults with CHC in the United States in 2020.
Prior cost analyses on the burden of hepatitis C exist; however, most available studies on the costs of CHC rely on claims data from 2001 to 2012 before the availability and transition to DAA therapy [6,7,8,9,10,11,12,13,14,15]. Recent studies provide economic burden estimates for the Medicaid and Veterans’ Affairs (VA) populations, excluding the commercially insured population [16, 17]. Existing cost studies also do not reflect the shifting landscape of new infections driven by increased injection drug use and the estimated prevalence of hepatitis C adjusted to account for persons who inject drugs (∼ 4.0 million) [18].
Marketscan is a healthcare utilization database that collects information on over 100 million people, comprised of commercially insured (employer-sponsored health insurance) for persons < 65 years and Medicare-eligible persons ≥ 65 years with Medicare supplemental insurance for a sub-set of Medicaid states.
Results
On average, medical costs per person in a disease stage were $89,070 (treated) and $150,669 (untreated) for non-cirrhosis, $104,961 (treated) and $197,469 (untreated) for cirrhosis, $59,120 (treated) and $208,646 (untreated) for decompensated cirrhosis, $44,876 (treated) and $113,975 (untreated) for hepatocellular carcinoma. The overall per person lifetime medical cost (weighted by the percentage of newly reported cases in each disease stage) was $90,089 (treated) and $155,930 (untreated). For a cohort of 2.228 million people, the projected total medical cost burden of CHC in 2022 dollars would be $200 billion if all were treated using DAAs, compared to $347 billion if all were untreated.
Conclusions
We found a substantial reduction in the overall lifetime medical costs of hepatitis C for persons treated with DAAs compared to untreated persons. These potential health care savings from expanded hepatitis C treatment underscore the importance of expanding HCV testing and DAA treatment as core components of the national strategy for hepatitis C elimination.
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