Alexis P Chidi1, Cindy L Bryce2, Julie M Donohue2, Michael J Fine3, Douglas P Landsittel4, Larissa Myaskovsky3, Shari S Rogal3, Galen E Switzer3, Allan Tsung3, Kenneth J Smith4. 1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System Pittsburgh, PA, USA. Electronic address: apc10@pitt.edu. 2. University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. 3. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System Pittsburgh, PA, USA. 4. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Abstract
BACKGROUND: Interferon-free hepatitis C treatment regimens are effective but very costly. The cost-effectiveness, budget, and public health impacts of current Medicaid treatment policies restricting treatment to patients with advanced disease remain unknown. OBJECTIVES: To evaluate the cost-effectiveness of current Medicaid policies restricting hepatitis C treatment to patients with advanced disease compared with a strategy providing unrestricted access to hepatitis C treatment, assess the budget and public health impact of each strategy, and estimate the feasibility and long-term effects of increased access to treatment for patients with hepatitis C. METHODS: Using a Markov model, we compared two strategies for 45- to 55-year-old Medicaid beneficiaries: 1) Current Practice-only advanced disease is treated before Medicare eligibility and 2) Full Access-both early-stage and advanced disease are treated before Medicare eligibility. Patients could develop progressive fibrosis, cirrhosis, or hepatocellular carcinoma, undergo transplantation, or die each year. Morbidity was reduced after successful treatment. We calculated the incremental cost-effectiveness ratio and compared the costs and public health effects of each strategy from the perspective of Medicare alone as well as the Centers for Medicare & Medicaid Services perspective. We varied model inputs in one-way and probabilistic sensitivity analyses. RESULTS: Full Access was less costly and more effective than Current Practice for all cohorts and perspectives, with differences in cost ranging from $5,369 to $11,960 and in effectiveness from 0.82 to 3.01 quality-adjusted life-years. In a probabilistic sensitivity analysis, Full Access was cost saving in 93% of model iterations. Compared with Current Practice, Full Access averted 5,994 hepatocellular carcinoma cases and 121 liver transplants per 100,000 patients. CONCLUSIONS: Current Medicaid policies restricting hepatitis C treatment to patients with advanced disease are more costly and less effective than unrestricted, full-access strategies. Collaboration between state and federal payers may be needed to realize the full public health impact of recent innovations in hepatitis C treatment.
BACKGROUND: Interferon-free hepatitis C treatment regimens are effective but very costly. The cost-effectiveness, budget, and public health impacts of current Medicaid treatment policies restricting treatment to patients with advanced disease remain unknown. OBJECTIVES: To evaluate the cost-effectiveness of current Medicaid policies restricting hepatitis C treatment to patients with advanced disease compared with a strategy providing unrestricted access to hepatitis C treatment, assess the budget and public health impact of each strategy, and estimate the feasibility and long-term effects of increased access to treatment for patients with hepatitis C. METHODS: Using a Markov model, we compared two strategies for 45- to 55-year-old Medicaid beneficiaries: 1) Current Practice-only advanced disease is treated before Medicare eligibility and 2) Full Access-both early-stage and advanced disease are treated before Medicare eligibility. Patients could develop progressive fibrosis, cirrhosis, or hepatocellular carcinoma, undergo transplantation, or die each year. Morbidity was reduced after successful treatment. We calculated the incremental cost-effectiveness ratio and compared the costs and public health effects of each strategy from the perspective of Medicare alone as well as the Centers for Medicare & Medicaid Services perspective. We varied model inputs in one-way and probabilistic sensitivity analyses. RESULTS: Full Access was less costly and more effective than Current Practice for all cohorts and perspectives, with differences in cost ranging from $5,369 to $11,960 and in effectiveness from 0.82 to 3.01 quality-adjusted life-years. In a probabilistic sensitivity analysis, Full Access was cost saving in 93% of model iterations. Compared with Current Practice, Full Access averted 5,994 hepatocellular carcinoma cases and 121 liver transplants per 100,000 patients. CONCLUSIONS: Current Medicaid policies restricting hepatitis C treatment to patients with advanced disease are more costly and less effective than unrestricted, full-access strategies. Collaboration between state and federal payers may be needed to realize the full public health impact of recent innovations in hepatitis C treatment.
Authors: M A Schnitzler; M A Skeans; D A Axelrod; K L Lentine; J E Tuttle-Newhall; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2015-01 Impact factor: 8.086
Authors: Peter Ferenci; David Bernstein; Jacob Lalezari; Daniel Cohen; Yan Luo; Curtis Cooper; Edward Tam; Rui T Marinho; Naoky Tsai; Anders Nyberg; Terry D Box; Ziad Younes; Pedram Enayati; Sinikka Green; Yaacov Baruch; Bal Raj Bhandari; Florin Alexandru Caruntu; Thomas Sepe; Vladimir Chulanov; Ewa Janczewska; Giuliano Rizzardini; Judit Gervain; Ramon Planas; Christophe Moreno; Tarek Hassanein; Wangang Xie; Martin King; Thomas Podsadecki; K Rajender Reddy Journal: N Engl J Med Date: 2014-05-04 Impact factor: 91.245
Authors: Robert J Wong; Maria Aguilar; Ramsey Cheung; Ryan B Perumpail; Stephen A Harrison; Zobair M Younossi; Aijaz Ahmed Journal: Gastroenterology Date: 2014-11-25 Impact factor: 22.682
Authors: Stefan Zeuzem; Ira M Jacobson; Tolga Baykal; Rui T Marinho; Fred Poordad; Marc Bourlière; Mark S Sulkowski; Heiner Wedemeyer; Edward Tam; Paul Desmond; Donald M Jensen; Adrian M Di Bisceglie; Peter Varunok; Tarek Hassanein; Junyuan Xiong; Tami Pilot-Matias; Barbara DaSilva-Tillmann; Lois Larsen; Thomas Podsadecki; Barry Bernstein Journal: N Engl J Med Date: 2014-04-10 Impact factor: 91.245
Authors: Adriaan J van der Meer; Bart J Veldt; Jordan J Feld; Heiner Wedemeyer; Jean-François Dufour; Frank Lammert; Andres Duarte-Rojo; E Jenny Heathcote; Michael P Manns; Lorenz Kuske; Stefan Zeuzem; W Peter Hofmann; Robert J de Knegt; Bettina E Hansen; Harry L A Janssen Journal: JAMA Date: 2012-12-26 Impact factor: 56.272
Authors: Nezam Afdhal; K Rajender Reddy; David R Nelson; Eric Lawitz; Stuart C Gordon; Eugene Schiff; Ronald Nahass; Reem Ghalib; Norman Gitlin; Robert Herring; Jacob Lalezari; Ziad H Younes; Paul J Pockros; Adrian M Di Bisceglie; Sanjeev Arora; G Mani Subramanian; Yanni Zhu; Hadas Dvory-Sobol; Jenny C Yang; Phillip S Pang; William T Symonds; John G McHutchison; Andrew J Muir; Mark Sulkowski; Paul Kwo Journal: N Engl J Med Date: 2014-04-11 Impact factor: 91.245
Authors: Philip R Spradling; Jian Xing; Loralee B Rupp; Anne C Moorman; Stuart C Gordon; Mei Lu; Eyasu H Teshale; Joseph A Boscarino; Mark A Schmidt; Yihe G Daida; Scott D Holmberg Journal: J Clin Gastroenterol Date: 2018-08 Impact factor: 3.062
Authors: Mina Kabiri; Jagpreet Chhatwal; Julie M Donohue; Mark S Roberts; A Everette James; Michael A Dunn; Walid F Gellad Journal: Healthc (Amst) Date: 2016-12-05
Authors: Holly McCready; Milky Kohno; Michael Kolessar; Laura Dennis; Daniel Kriz; Hannah Luber; Renee Anderson; Michael Chang; Anna Sasaki; Kenneth Flora; Arthur Vandenbark; Suzanne H Mitchell; Jennifer M Loftis; William F Hoffman; Marilyn Huckans Journal: J Neurovirol Date: 2018-10-08 Impact factor: 2.643
Authors: Lauren F Collins; Austin Chan; Jiayin Zheng; Shein-Chung Chow; Julius M Wilder; Andrew J Muir; Susanna Naggie Journal: Open Forum Infect Dis Date: 2017-12-09 Impact factor: 3.835
Authors: Nadia A Nabulsi; Michelle T Martin; Lisa K Sharp; David E Koren; Robyn Teply; Autumn Zuckerman; Todd A Lee Journal: Front Pharmacol Date: 2020-11-13 Impact factor: 5.810