Efficient care delivery of effective hepatitis C virus treatments in Medicaid beneficiaries without cirrhosis

Abstract

The hepatitis C virus (HCV) targets the liver and increases the chance of negative liver-related health outcomes. The recent wave of direct-acting antiviral (DAA) treatments is highly effective, with reduced side effects compared to prevailing options, and is recommended by the American Association for the Study of Liver Disease–Infectious Diseases Association (AASLD–IDSA), as of June 2017. In the administration of DAA treatment in Medicaid, however, patients with cirrhosis have been given priority. The extent of efficiency and cost savings associated with delivery of treatments in patients without cirrhosis is in question. The aim of this study was to analyse the efficiency of HCV treatment options and practice recommendations in Medicaid beneficiaries as a national cohort. To quantitatively evaluate treatment efficiency, treatments recommended by AASLD–IDSA were modelled using inputs from the published literature and the Medicaid National Average Drug Acquisition Cost. For modelled patients, ombitasvir/paritaprevir/ritonavir/dasabuvir/ribavirin would be the preferred, most efficient and effective treatment for Medicaid. Despite real world variation in treatment discontinuation, DAA treatment results in savings for Medicaid. The results suggest that DAA regimens as a first line of treatment is both an effective and an efficient practice in patients without cirrhosis, reducing all-cause health-care costs, preventing disease stage progression and averting morbidity.