Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection
Despite the high efficacy and safety associated with direct-acting antivirals (DAAs), access to HCV treatment has been frequently restricted because of the high DAA drug costs.
To (1) compare HCV treatment initiation rates between HCV monoinfected and HCV/HIV coinfected patients before (pre-DAA period) and after (post-DAA period) all-oral DAAs became available; and to (2) estimate the HCV treatment costs for payers and patients.
Research Design and Methods
A retrospective analysis of the MarketScan® Databases (2009–2016) was conducted for newly diagnosed HCV patients. Multivariable logistic regression was used to estimate the odds ratio (OR) of initiating HCV treatments during the pre-DAA and post-DAA periods. Kruskal–Wallis test was used to compare drug costs for dual, triple and all-oral therapies.
A total of 15,063 HCV patients [382 (2.5%) HIV coinfected] in the pre-DAA period and 14,896 [429 (2.9%) HIV coinfected] in the post-DAA period were included. HCV/HIV coinfected patients had lower odds of HCV treatment uptake compared to HCV monoinfected patients during the pre-DAA period [OR, 0.59; 95% confidence interval (CI), 0.45–0.78], but no significant difference in odds of HCV treatment uptake was observed during the post-DAA period (OR, 1.08; 95% CI, 0.87–1.33). From 2009 to 2016, average payers’ treatment costs (dual, $20,820; all-oral DAAs, $99,661; p < 0.001) as well as average patients’ copayments (dual, $593; all-oral DAAs $933; p < 0.001) increased significantly.
HCV treatment initiation rates increased, especially among HCV/HIV coinfected patients, from the pre-DAA to the post-DAA period. However, payers’ expenditures per course of therapy saw an almost fivefold increase and patients’ copayments increased by 55%.
KeywordsHepatitis C HIV Coinfection Treatment initiation Drug costs
Direct-acting antiviral agents
Healthcare Common Procedure Coding System
Hepatitis C virus
Human immunodeficiency virus
International Classification of Diseases
National Drug Code
Organisation for Economic Co-operation and Development
Sustained virologic response
Veterans Health Administration
Research reported in this publication was supported in part by the National Institute on Drug Abuse of the National Institutes of Health under Award No. K01DA045618 (to HP).
- 7.AASLD/IDSA. Recommendations for testing, managing, and treating hepatitis C. available at: http://Www.hcvguidelines.org. Updated: September 21, 2017; Accessed 30.03.18.
- 12.Abara WE, Moorman AC, Zhong Y, et al. The predictive value of international classification of disease codes for chronic hepatitis C virus infection surveillance: the utility and limitations of electronic health records. Popul Health Manag. 2018;21:110–115. https://doi.org/10.1089/pop.2017.0004.CrossRefGoogle Scholar
- 14.US Bureau of Economic Analysis. GDP & personal income, table 2.5.4. price indexes for personal consumption expenditures by function. https://www.bea.gov/ updated: Aug 3, 2017; Accessed 25.04.18.
- 16.Oramasionwu CU, Kashuba AD, Napravnik S, Wohl DA, Mao L, Adimora AA. Non-initiation of hepatitis C virus antiviral therapy in patients with human immunodeficiency virus/hepatitis C virus co-infection. World J Hepatol. 2016;8:368–375. https://doi.org/10.4254/wjh.v8.i7.368.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Cope R, Glowa T, Faulds S, McMahon D, Prasad R. Treating hepatitis C in a ryan white-funded HIV clinic: has the treatment uptake improved in the interferon-free directly active antiviral era? AIDS Patient Care STDS. 2016;30:51–55. https://doi.org/10.1089/apc.2015.0222.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.European Association for the Study of the Liver. Electronic address: firstname.lastname@example.org. EASL recommendations on treatment of hepatitis C 2016. J Hepatol. 2016;66:153–194.Google Scholar
- 33.Alavi M, Spelman T, Matthews GV, et al. Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: the Australian trial in acute hepatitis C. Int J Drug Policy. 2015;26:976–983. https://doi.org/10.1016/j.drugpo.2015.05.003.CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Sinnott SJ, Buckley C, O’Riordan D, Bradley C, Whelton H. The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta-analysis. PLoS ONE. 2013;8:64914. https://doi.org/10.1371/journal.pone.0064914.CrossRefGoogle Scholar