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Hepatitis C Cure Is Associated with Decreased Healthcare Costs in Cirrhotics in Retrospective Veterans Affairs Cohort

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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.

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Funding

No financial arrangements were related to the research. No outside assistance was received for manuscript preparation.

Author information

Authors and Affiliations

  1. VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Mail code L457, Portland, OR, 97239, USA

    Marissa M. Maier

  2. Oregon Health and Sciences University, School of Medicine, Portland, OR, USA

    Marissa M. Maier

  3. VA Puget Sound Health Care System, B313 Padelford Hall, NE Stevens Way, Seattle, WA, 98195, USA

    Xiao-Hua Zhou

  4. University of Washington, School of Public Health, Seattle, WA, USA

    Xiao-Hua Zhou & Michael Chapko

  5. VA Puget Sound HSR&D, Metro Park West, Suite 1400, 1100 Olive Way, Seattle, WA, 98101, USA

    Michael Chapko

  6. VA Puget Sound HSR&D, 1660 South Columbian Way, Seattle, WA, 98108, USA

    Steven L. Leipertz

  7. School of Mathematics, Zhejiang University, Hangzhou, Zhejiang, China

    Xuan Wang

  8. VA Puget Sound Health Care System, 1660 S. Columbian Way (S-111-GI), Seattle, WA, 98108, USA

    Lauren A. Beste

  9. University of Washington, School of Medicine, Seattle, WA, USA

    Lauren A. Beste

Authors
  1. Marissa M. Maier
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  2. Xiao-Hua Zhou
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  3. Michael Chapko
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  4. Steven L. Leipertz
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  5. Xuan Wang
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  6. Lauren A. Beste
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Corresponding author

Correspondence to Marissa M. Maier.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This operational evaluation project was sponsored by the VA Office of HIV, Hepatitis, and Public Health Pathogens Program. The activities were undertaken in support of VA operational programs and did not constitute research, in whole or in part, in compliance with VA Handbook 1058.05. Therefore, institutional review board approval was not required.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

As our evaluation project was retrospective, formal consent is not required.

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Maier, M.M., Zhou, XH., Chapko, M. et al. Hepatitis C Cure Is Associated with Decreased Healthcare Costs in Cirrhotics in Retrospective Veterans Affairs Cohort. Dig Dis Sci 63, 1454–1462 (2018). https://doi.org/10.1007/s10620-018-4956-0

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  • DOI: https://doi.org/10.1007/s10620-018-4956-0

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