Pid8: Costs of Health Care for Hepatitis C-Infected Members in a Managed Care Organization (Mco)

Abstract

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.