Los Angeles—New treatments for curing hepatitis C might be expensive, but paying for them now ends up being considerably less expensive than continuing to pay for older medications or for the consequences of delayed treatment, such as liver cancer, according to new research.
The question raised in the group of studies, published recently in a special edition of the American Journal of Managed Care, is how to reward private insurance companies so that they will bear the cost of the treatment early on even though they are less likely to recoup the costs in the long run, as patients move on to other insurers or Medicare.
“Many policymakers have focused on what they see as a high price for three months of therapy, but the value of curing hepatitis C lasts a lifetime,” said lead author of one of the studies, Darius Lakdawalla, PhD, of the University of Southern California Schaeffer Center for Health Policy and Economics.
Background information in the article notes that half of Americans with HCV have not yet been diagnosed, with the estimated 3.5 million with the disease likely to be baby boomers who became infected through blood transfusions before new federal regulations for the blood supply went into effect in the 1980s.
The CDC reported this month that a record number of Americans, 19,659, died of HCV in 2014, and that annual hepatitis C–related mortality in 2013 surpassed the total combined number of deaths from 60 other infectious diseases reported to CDC, including HIV, pneumococcal disease, and tuberculosis.
The industry-sponsored studies in AJMC point out that only 13% to 36% of U.S. patients with chronic HCV have been treated and not all of those have completed the necessary treatment regimen to cure the disease. Researchers suggest that broader financing of HCV treatment would not only save lives but would also lower future costs for Medicare and reduce the need for expensive liver transplants.
In fact, the studies suggest that universal screening and treatment of all HCV patients—no matter the disease stage—would generate more than $800 billion in benefits over 20 years, taking into account improved health and longer lives.
The problem, according to study authors, is persuading private insurers to expand coverage and treat patients at earlier stages of the disease, especially if doing so would save Medicare $4 billion to $11 billion in 20 years. While private insurers also would benefit from savings—$10 billion to $14 billion over the two decades—their short-term costs would be substantial, according to the report.
Another of the studies evaluated the costs and benefits of treating HCV before the disease progresses to a point where liver transplant is required. “Systematic HCV screening and treatment could spare 10,490 liver transplants to HCV-infected patients from 2015 to 2035,” wrote study authors led by Harvard Medical School researchers. “An estimated 7,321 transplants would accrue to patients with end-stage liver disease without HCV.”
“Policymakers must determine how to encourage private insurers to undertake these short-term costs in the service of substantial long-term benefits,” Lakdawalla said in a USC press release. “Innovative policies that allow private insurers to harvest the savings they create—even when they accrue to other insurers down the road—may represent a critical strategy for help society unlock the value of cures for hepatitis C and other diseases.”
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