Healthcare costs and resource utilization in treated versus untreated chronically infected hepatitis C patients
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Successful treatment of chronic hepatitis C virus (HCV) leads to significant benefits in both hepatic and extrahepatic morbidity and mortality. However, treatment is costly and onerous. The purpose of this study was to evaluate the resource utilization and healthcare costs of chronic HCV patients who are treated versus those who are not treated. Patients eligible for this study were Texas Medicaid patients ≥18 and ≤63 years who had evidence of chronic HCV during the identification period (1/1/07-9/30/11) and continuous enrollment throughout the analysis period. High dimensional propensity scoring techniques were used to match treated vs. untreated patients (1:2 ratio). Unadjusted and adjusted analyses compared the healthcare costs and utilization between patient cohorts at 6 and 18 months. For those treated, adherence was measured by proportion of days covered and persistence was evaluated as a gap in medication (of one fill) as determined by refill records. There were a total of 24,032 patients identified with chronic HCV. After high dimensional propensity scoring, there were no significant differences in key clinical and demographic characteristics between treated (n=939) and untreated (n=1878) cohorts. Over 97% of patients had evidence of end stage liver disease at baseline. Based on adjusted analyses of total costs using a generalized linear regression model, the mean difference in costs between the treated vs. untreated patients was $13,960 (SE $458, p<0.001). At 18 months of follow-up, the adjusted mean all-cause costs were $20,834 higher for treated patients (n=456) compared to those untreated (n=849) (p<0.001); however, mean outpatient costs were $1,894 (SE $274) less in treated vs. untreated patients. For those treated, the average HCV medication PDC was 71%, and by the end of 24 weeks, only 42.3% of patients remained on HCV therapy. This study did not show short-term cost offsets, but the sub-analysis following patients for 18 months showed trends in downstream cost offsets. Most patients had advanced liver disease, reducing the chances of successful treatment and averting liver disease sequelae. Earlier identification and treatment could bend the cost curve before these patients reached the more advanced stages seen in this costly cohort.