Expanding access to hepatitis C treatment would reduce healthcare cost

A nonpartisan analysis for the United States Congress published by the Congressional Budget Office found that increasing access to hepatitis C treatment among Medicaid enrollees could have significant financial benefits over the next decade. More specifically, the report estimates that doubling access could save $7 billion in healthcare costs in the next ten years.

Hepatitis C is a viral infection spread through direct contact with infected blood. The infection typically begins with an acute phase that is often asymptomatic; however, over time, long-term infections called chronic hepatitis C can damage the liver.

The report explains that the condition’s prevalence is difficult to estimate because many people who have the condition are asymptomatic and unaware of their infection status. Although 25% of individuals clear the virus without an intervention, 75% of cases become chronic, which can result in cirrhosis and an elevated risk of liver cancer.

The budget office explained that the cost of treating advanced hepatitis C with severe liver complications is about 10 times greater than treating earlier stages of the disease.

According to the report, the virus can be treated with direct-acting antiviral medications, effective in 95% of cases within 8–12 weeks. The report notes, “The treatment consists of tablets taken each day. Cure rates remain near 95% even among patients who miss doses throughout their course of treatment; however, people who complete less than 4 weeks of treatment are less likely to be cured.”

The report examined two five-year program illustrations of increased hepatitis C treatment. One estimate examined the financial impacts of increasing treatment by 10% among Medicaid enrollees, while the other examined the effect of increasing treatment by 100%.

A 10% increase in hepatitis C treatment would require spending $0.5 billion in treatment and testing over one decade; however, the savings would be significantly greater at $0.7 billion. Additionally, a 100% increase in treatment results in $4 billion in healthcare spending but allows for $7 billion in savings, resulting in net savings.

However, to effectively increase treatment, additional resources would need to be allocated to outreach for expanded testing and treatment, which was not considered in this analysis.

The report notes, “CBO has not estimated the federal budgetary effects of any particular policy aimed at increasing hepatitis C treatment rates. The direction and size of those effects would depend on factors such as the number of people who have newly begun treatment with direct-acting antiviral (DAA) medications, their insurance coverage, the amount of federal spending to cover the costs of DAA treatment, spending on and success of outreach efforts and mechanisms put in place to ensure adherence to treatment, and the magnitude and timing of savings from healthcare costs avoided by increased hepatitis C treatment.”