A restrictive Medicaid policy in many states limits hepatitis C virus (HCV) treatment to patients with severe disease, which leads to suboptimal treatment outcomes, high patient burden, and excessive costs. Now, a new study showed that a “treat-all” Medicaid approach offers better outcomes, considerably reduces healthcare costs, and patients are less prone to develop other diseases.
The findings were published in The American Journal of Managed Care in an article titled “Treating Medicaid Patients With Hepatitis C: Clinical And Economic Impact.”
“Access to HCV treatment under current state Medicaid programs is highly heterogeneous,” researchers wrote. “Although HCV treatment qualification has become less stringent in some states, others refuse coverage, have instituted criteria for only treating patients with advanced fibrosis, or have not yet considered adding DAAs [direct-acting antivirals] to their formularies.”
“This strategy is flawed: First, patients with advanced fibrosis are more difficult to treat; second, fibrosis is a surrogate for liver-related mortality and fails to account for other negative impacts of HCV on patients and their well-being.” the authors noted.
Researchers followed a group of 120,980 patients with HCV (type 1) insured under Medicaid over their lifetime. These patients had been either treated under state-specific restrictions imposed by fibrosis stage, treated under the all-patient strategy with an approved oral combination of ledipasvir/sofosbuvir (LDV/SOF; eight or 12-week treatment, depending on viral load, cirrhosis status, and state-specific LDV/SOF restrictions), or untreated.
The analysis showed that the “treat-all” approach provided a higher sustained virologic response rates than the LDV/SOF restriction strategy (95.9 percent vs. 75.2 percent). A sustained virologic response reflects the absence of detectable HCV in the blood.
Moreover, treating all eligible Medicaid patients with LDV/SOF resulted in 36,752 fewer cases of cirrhosis (liver damage), 1,739 fewer liver transplants, 8,169 fewer cases of hepatocellular carcinoma, and 16,173 fewer HCV-related deaths. It also added 0.84 life-years and 1.03 quality-adjusted life-years per patient.
In terms of cost savings, the less restrictive approach led to 39.4 percent ($3.8 billion) in savings and reduced by 18.3 percent the burden of total costs associated with negative outcomes.
“Institution of a less restrictive ‘treat all’ strategy in Medicaid patients was associated with clinical outcome and cost benefits,” researchers concluded. “Based on these data, we believe it is time to develop a national strategy to eradicate HCV from the United States regardless of payer status. Such a strategy requires collaboration among private payers, governmental payers (including Medicaid), healthcare providers, drug manufacturers, and patients.”