Approximately 2.7 million Americans have active Hepatitis C infection. Combination therapy with ribavirin and interferon alfa‐2b has emerged as the treatment of choice for Hepatitis C. OBJECTIVES: To determine if the prescribing of combination therapy differed among ethnic groups in Hepatitis C‐infected members during calendar year 1999 in a Medicaid MCO. METHODS: Hepatitis C‐infected patients were identified from a database of continuously enrolled members of an inner‐city Medicaid MCO in Philadelphia using ICD‐9 codes indicative of Hepatitis C (070.41, 070.44, 070.51, 070.54, 571.40, 571.41, V02.60, V02.62). From this population, members who received combination therapy with ribavirin and interferon alfa‐2b were identified and demographic information was obtained. Variation in the prescribing of combination therapy among ethnic groups was assessed using a Chi‐square test. RESULTS: From a cohort of 73,869 members, 395 members (0.535%) had an ICD‐9 code for Hepatitis C. Of those, 60 members had pharmacy claims for combination therapy during 1999. These members aged from 23 to 64 years (mean age = 45.0 yrs; SD = 7.6). Based on the ethnic distribution of the 395 members with an ICD‐9 code for Hepatitis C, 8.4% (16/191) of African‐Americans were prescribed combination therapy compared with 23% (28/122) of Caucasians, 22.7% (15/66) of Latinos and 14.3% (1/7) of Asian‐Americans. A statistically significant difference in the prescribing of combination therapy was noted among ethnic groups (p < 0.05). CONCLUSIONS: Within this Medicaid MCO, a disproportionately low percentage of African–American members received combination therapy for Hepatitis C during 1999. It is unknown whether this was due to a disproportionate number of contraindications in this group, inequitable prescribing habits of physicians, cultural barriers preventing consent for treatment, or noncompliance with obtaining the medication. Further investigation is needed to determine why this disparity exists so that differences in treatment among ethnic groups may be minimized.
The current literature provides limited information about the cost‐burden of Hepatitis C. OBJECTIVES: To identify all medical and pharmacy costs accrued by members with Hepatitis C in a Medicaid MCO during 1999. METHODS: Hepatitis C‐infected patients were identified from a database of continuously enrolled members from an inner‐city Medicaid MCO in Philadelphia during 1999 using ICD‐9 codes indicative of Hepatitis C. Medical and pharmacy claims for these identified members during this study period were obtained and analyzed. A subanalysis comparing patients prescribed combination ribavirin/interferon alfa‐2b therapy with patients not prescribed combination therapy was performed. Costs were reported as reimbursements paid for medical claims and pharmacy claims (AWP—14.5%). RESULTS: From a cohort of 73,869 members, 395 members (0.535%) met inclusion criteria for Hepatitis C. The mean age was 46.5 years (SD = 9.5; range = 4–81) and 213 (53.9%) were male. These members had 17,507 medical claims resulting in payments of $4,075,082. Inpatient hospital services accounted for 48% of these costs. There were 27,681 pharmacy claims that totaled $1,495,096. Sixty patients received combination therapy, which totaled $375,468 in pharmacy claims (n = 444). Comparing patients prescribed combination therapy and patients not prescribed combination therapy, medical costs were $2,580/member and $11,702/member, respectively. In addition, pharmacy costs were $8,610/member and $2,920/member, respectively. Total costs in 1999 for patients prescribed combination therapy was $11,190/member and for patients not prescribed combination therapy was $14,622/member. These results were not adjusted for disease severity. CONCLUSIONS: Hepatitis C is a very costly disease. Total health care costs to this Medicaid MCO during 1999 for the 395 members identified with Hepatitis C exceeded $5.5 million. In addition, total costs were less for members prescribed combination ribavirin/interferon alfa‐2b therapy compared with members not prescribed combination therapy. Further investigation is needed to explain the observed differences in health care expenditures between these two populations.
Although information exists in the form of projected costs, limited data are available on the overall cost of illness resulting from varicella‐zoster virus (VZV) infection. VZV is usually a benign childhood illness, but reactivation of latent VZV can lead to serious complications. OBJECTIVE: To assess via medical claims the costs associated with VZV infection and its resultant complications from the payers' perspective. METHODS: We conducted a retrospective database analysis of 73,869 managed care members continuously enrolled throughout calendar year 1999. Records of members with a diagnosis code of either primary varicella (ICD9‐052) or herpes zoster (ICD‐053) were selected. Data was extracted and cost information was tallied for all medical claims including inpatient hospitalizations, primary care visits, specialist visits, emergency department visits, and specialty procedures. Cost data are reported in 1999 US dollars. RESULTS: In 1999, a total of 119 patients were diagnosed with varicella (52%) and herpes zoster (48%). The mean cost to the payer was $496.77/patient. The average amount paid out for members with varicella was $181.87. The average cost per member with herpes zoster was $786.27. Sixty‐two (52%) VZV afflicted members were diagnosed with varicella while 57 were diagnosed with herpes zoster. The amount paid for members over age 19 (n = 56) was $640.30/patient. Of these patients, 14% were classified with varicella infection, whereas 86% were classified as having zoster. For members aged <19 (n = 63), the mean amount paid was $369.18/patient. In this group, 78% were diagnosed with varicella infection, whereas 22% were diagnosed with zoster. CONCLUSION: The above costs document for the first time the true cost of VZV infection from the payers' perspective. Further efforts to expand vaccination programs should take these costs into consideration.
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