Cost-benefit analysis of recommended treatments for hepatitis C virus genotype 1a infected Medicaid beneficiaries

Sarita Mantravadi, The University of Texas School of Public Health

Abstract

This study is a cost-benefit analysis of hepatitis C virus infection treatment options, for Medicaid enrollees with genotype 1a, from the payer perspective of Medicaid, covering the highly efficacious but relatively expensive direct-acting antiviral treatment regimens recently approved by the Food and Drug Administration (FDA), relative to costs and benefits of the recognized interferon/ribavirin regimen and relative to a watch-and-wait/no treatment strategy. ^ State Medicaid programs, and the Center for Medicare and Medicaid Services, are facing pressure to broadly approve the new regimens, which would require great up-front monetary outlays. Would the long-term benefits, in terms of health care utilization costs averted, be worth the up-front costs? This study modeled annual clinical progression annually for these regimens across ten years for two cohorts of Medicaid beneficiaries, those with and without cirrhosis at baseline, including individuals up to the age of 55. ^ To develop the model, data values were drawn from recognized sources. Regimen efficacy values were drawn from published peer-reviewed trial data and supporting materials. Drug costs were determined from the Medicaid National Average Drug Acquisition Cost. Treatment regimens included those recognized, as of June 25 2016, by The American Association for the Study of Liver Disease and the Infectious Disease Society of America. Costs were these regimen costs, and benefits were modeled in terms of averted health care costs, relative to no treatment. ^ Across possible recognized disease progression stages, annual treatment and health care costs were accumulated, over ten years, for each regimen. The net present value and benefit/cost ratio was modeled for each treatment regimen. A 3% discounting rates was applied, and, in order to explore the robustness of conclusions to variation in assumptions, sensitivity analyses for retreatment, treatment discontinuation, sustained virologic response rate, and medication costs were conducted. ^ For the Medicaid patient cohort without cirrhosis, across ten years, relative to no treatment, the following health care savings, in terms of net present value, were modeled for each of the following regimens: ombitasvir/ paritaprevir/ritonavir/dasabuvir and ribavirin, $10.9 billion savings; elbasvir-grazoprevir, $6.9 billion; sofosbuvir-ledipasvir, $2.6 billion; peginterferon/ribavirin, $860 million; daclatasvir-sofosbuvir, -3.4 billion (more costly than no treatment/watch-and-wait); simeprevir-sofosbuvir, -$3.9 billion (more costly than no treatment/watch-and-wait). Respectively, benefit/cost ratios for each of these regimens were: 5.61; 2.09; 1.25; 1.08; 0.79; and 0.77. ^ For the Medicaid patient cohort with cirrhosis, across ten years, relative to no treatment, the following health care savings, in terms of net present value, were modeled for each of the following regimens: elbasvir-grazoprevir, $5.3 billion; sofosbuvir-ledipasvir, $1.1 billion; peginterferon/ribavirin, -$1.4 billion (more costly than no treatment/watch-and-wait). Respectively, benefit/cost ratios for each of these regimens were: 1.83; 1.10; and 0.87. ^ From the Medicaid payer perspective, some “all-pill” direct-acting antiviral regimens for chronic hepatitis seem to be a good value, relative to the prevailing peginterferon-alpha/ribavirin regimen or to watch-and-wait/no treatment, when estimated across ten years. Considering the need to maximize Medicaid dollars, this cost-benefit analysis may contribute to Medicaid policy regarding approval of this new generation of highly effective but relatively expensive treatments for chronic hepatitis C virus infection.^

Subject Area

Economics|Health sciences|Health care management

Recommended Citation

Mantravadi, Sarita, "Cost-benefit analysis of recommended treatments for hepatitis C virus genotype 1a infected Medicaid beneficiaries" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10182170.
http://digitalcommons.library.tmc.edu/dissertations/AAI10182170

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