In the United States in 2014, more than 3 million individuals were estimated to have chronic hepatitis C virus (HCV) infection, including many undiagnosed individuals. In 2012, the Centers for Disease Control and Prevention expanded its HCV testing recommendations to target all adults born between 1945 and 1965, in addition to at-risk individuals. This has led to an increase in newly diagnosed patients. Few studies have explored the medical cost or clinical status of patients who are newly diagnosed with HCV. This research by Milliman consultants compares the demographics, comorbidities, and medical costs of patients who are newly diagnosed and those who were previously diagnosed with HCV infection.
The high cost of therapy for patients with chronic hepatitis C (HCV) infection has been an important topic of discussion for key stakeholders in pharmacy benefit design and management. Multiple effective treatments have been introduced, with cure rates approaching 100%.
Although costly, curing HCV early on can prevent serious liver complications, such as hepatic cirrhosis, organ failure, and cancer, for the approximately 2.7 million affected people in the United States.
In 2016, there was a downward cost and utilization trend for the HCV Specialty category. Express Scripts reported in its 2016 Drug Trend Report that utilization of HCV therapies had decreased by 27.3% and the unit cost had decreased by 6.7%. The cost per member per year (PMPY) for HCV drugs decreased to $25.26 PMPY from $38.44 PMPY the previous year.
Why have cost and utilization suddenly decreased after two years of steady growth?
Changes from the Patient Protection and Affordable Care Act (ACA) are dominating the healthcare landscape. These changes are very important for people infected with the hepatitis C virus (HCV). Last year there was an increased federal public health effort aimed at diagnosing people with HCV. Baby Boomers, the generation with the most HCV-infected people, has started to become eligible for Medicare.
Further, new treatments for HCV are under development. Undiagnosed individuals and uninsured individuals may represent a population that payors and stakeholders have not yet experienced. This paper discusses how increased diagnosis, increased Medicare eligibility, and newly insured individuals with HCV will affect the U.S. healthcare system.
The Concord Monitor is running a series on hepatitis C (HCV) . A first-person article written by a carrier and published today frames the challenge:
HCV is often called “the silent epidemic” because many carriers have no idea they’re infected, and most people have never heard of the disease. But silent doesn’t mean benign. Left untreated, it can cause serious liver damage and liver cancer, and it is the leading cause of liver transplant in this country. It kills about 10,000 Americans a year, and the National Foundation for Infectious Disease predicts that number will triple in the next 20 years as more and more carriers reach end-stage liver disease.
The economic costs are staggering, too. A report released last year by the actuarial firm Milliman Inc. estimates that HCV patients in the U.S. require about $30 billion in medical care annually. The price tag will grow over the next two decades, according to the study, costing public and private health insurers $85 billion a year by 2027. Because the majority of HCV-positive Americans are baby boomers, Medicare will be responsible for nearly half the bill.
The New York Times considers the long-term implications of hepatitis C and the efforts to treat it with drugs that are now becoming available. Here is an excerpt:
But even if the [hepatitis C] drugs do work, some experts and doctors warn that this virus may be particularly tough to vanquish. Three-quarters of the people who are infected do not know it because they are not tested for the virus and because the infection can be asymptomatic for years while it stealthily attacks the liver.
And because this disease is transmitted by blood, those infected largely are former or current IV-drug users — a population that characteristically has little or no health insurance — who may not be the most able to stick to a lengthy treatment regimen that can cause brutal side effects…
Vertex has commissioned studies projecting a rising toll from hepatitis C. One such study, done by Milliman, a health insurance consulting firm, projected that the number of people with advanced liver disease from hepatitis C would quadruple in 20 years if treatment did not improve.
The Milliman report is available here.
The House Oversight and Government Reform Committee yesterday considered a bill to improve detection and treatment of hepatitis C. Here is an excerpt from the testimony of Louisiana congressman Bill Cassidy:
While new HCV infections have declined over the past two decades, there are at least 3 million Americans with chronic HCV. According to the 2009 Milliman Report, Consequences of Hepatitis C Virus: Cost of a Baby Boomer Epidemic of Liver Disease, most of our infected population are baby boomers.