Marissa M Maier1,2, Xiao-Hua Zhou3,4, Michael Chapko4,5, Steven L Leipertz6, Xuan Wang7, Lauren A Beste8,9. 1. VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Mail code L457, Portland, OR, 97239, USA. Marissa.Maier@va.gov. 2. Oregon Health and Sciences University, School of Medicine, Portland, OR, USA. Marissa.Maier@va.gov. 3. VA Puget Sound Health Care System, B313 Padelford Hall, NE Stevens Way, Seattle, WA, 98195, USA. 4. University of Washington, School of Public Health, Seattle, WA, USA. 5. VA Puget Sound HSR&D, Metro Park West, Suite 1400, 1100 Olive Way, Seattle, WA, 98101, USA. 6. VA Puget Sound HSR&D, 1660 South Columbian Way, Seattle, WA, 98108, USA. 7. School of Mathematics, Zhejiang University, Hangzhou, Zhejiang, China. 8. VA Puget Sound Health Care System, 1660 S. Columbian Way (S-111-GI), Seattle, WA, 98108, USA. 9. University of Washington, School of Medicine, Seattle, WA, USA.
Abstract
BACKGROUND: Approximately 233,898 individuals in the Veterans Affairs healthcare network are hepatitis C virus (HCV)-infected, making the Veterans Affairs the single largest provider of HCV care in the USA. Direct-acting antiviral treatment regimens for HCV offer high cure rates. However, these medications pose an enormous financial burden, and whether HCV cure is associated with decreased healthcare costs is poorly defined. AIMS: To measure downstream healthcare costs in a national population of HCV-infected patients up to 9 years post-HCV antiviral treatment, to compare downstream healthcare costs between cured and uncured patients, and to assess impact of cirrhosis status on cost differences. METHODS: This is a retrospective cohort study (2004-2014) of hepatitis C-infected patients who initiated antiviral treatment within the United States Veterans Affairs healthcare system October 2004-September 2013. We measured inpatient, outpatient, and pharmacy costs after HCV treatment. RESULTS: For the entire cohort, cure was associated with mean cumulative cost savings in post-treatment years three-six, but no cost savings by post-treatment year nine. By post-treatment year nine, cure in cirrhosis patients was associated with a mean cumulative cost savings of $9474 (- 32,666 to 51,614) per patient, while cure in non-cirrhotic patients was associated with a mean cumulative cost excess of $2526 (- 12,211 to 7159) per patient. CONCLUSIONS: Among patients with cirrhosis at baseline, cure is associated with absolute cost savings up to 9 years post-treatment compared to those without cure. Among patients without cirrhosis, early post-treatment cost savings are counterbalanced by higher costs in later years.
BACKGROUND: Approximately 233,898 individuals in the Veterans Affairs healthcare network are hepatitis C virus (HCV)-infected, making the Veterans Affairs the single largest provider of HCV care in the USA. Direct-acting antiviral treatment regimens for HCV offer high cure rates. However, these medications pose an enormous financial burden, and whether HCV cure is associated with decreased healthcare costs is poorly defined. AIMS: To measure downstream healthcare costs in a national population of HCV-infectedpatients up to 9 years post-HCV antiviral treatment, to compare downstream healthcare costs between cured and uncured patients, and to assess impact of cirrhosis status on cost differences. METHODS: This is a retrospective cohort study (2004-2014) of hepatitis C-infectedpatients who initiated antiviral treatment within the United States Veterans Affairs healthcare system October 2004-September 2013. We measured inpatient, outpatient, and pharmacy costs after HCV treatment. RESULTS: For the entire cohort, cure was associated with mean cumulative cost savings in post-treatment years three-six, but no cost savings by post-treatment year nine. By post-treatment year nine, cure in cirrhosispatients was associated with a mean cumulative cost savings of $9474 (- 32,666 to 51,614) per patient, while cure in non-cirrhotic patients was associated with a mean cumulative cost excess of $2526 (- 12,211 to 7159) per patient. CONCLUSIONS: Among patients with cirrhosis at baseline, cure is associated with absolute cost savings up to 9 years post-treatment compared to those without cure. Among patients without cirrhosis, early post-treatment cost savings are counterbalanced by higher costs in later years.
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