Prevalence and economic burden of extrahepatic manifestations of hepatitis C virus are underestimated but can be improved with therapy

Abstract

Despite guideline recommendations, access to hepatitis C virus (HCV) treatment is frequently restricted, with some payers approving therapy for only those with advanced disease or cirrhosis. However, delaying potentially curative treatment until the development of advanced liver disease may have costly consequences in terms of both hepatic complications and extrahepatic manifestations (EHMs) of HCV. Using a large claims database from the United States, we measured the risks and medical costs of 20 EHMs and investigated the role of treatment in different stages of liver fibrosis for mitigating the clinical and economic burden of these EHMs. After adjusting for potential confounders, including comorbid liver disease, patients with HCV had a significantly higher risk for any EHM (adjusted odds ratio, 2.23; P < 0.05) and higher EHM‐related annual medical costs (adjusted medical cost difference, $6,458; P < 0.05) compared to matched patients without HCV. HCV treatment can offset the higher medical costs in patients with HCV by saving ∼$25,000 in all‐cause medical costs per patient per year, with a large proportion attributable to savings in EHM‐related medical costs (adjusted cost difference $12,773, P < 0.05). Finally, additional EHM‐related medical costs could be saved by initiating HCV therapy in early stage fibrosis as opposed to late‐stage fibrosis (adjusted medical cost difference, $10,409; P < 0.05). Conclusion: The clinical and economic burden of EHMs is substantial and can be reduced through viral eradication, especially if treatment is initiated early and not delayed until fibrosis advances. Considering that the wholesale acquisition cost of a 12‐week course of therapy ranges from $55,000 to $147,000, the results of the current study suggest the cost of these treatments could be offset within 3 to 6 years by savings in all‐cause medical costs. (Hepatology Communications 2017;1:439–452)

Impact of All‐Oral Direct‐Acting Antivirals on Clinical and Economic Outcomes in Patients With Chronic Hepatitis C in the United States

“…Although we did not observe decreased costs in the DAA group among patients without cirrhosis, we believe that over time the savings associated with the avoidance of advanced liver disease and other complications of HCV will be offset, as predicted by several economic investigations in which DAA therapy was found to be cost‐effective in the long term . Furthermore, although we did not study HCV‐associated extrahepatic manifestations in this study, previous investigators found that a large proportion of all‐cause medical costs were attributable to extrahepatic manifestation–related costs in patients with HCV, adding strength to our findings that treatment with DAAs can reduce the high medical costs in patients with HCV by saving in both liver complications and extrahepatic manifestations avoided with cure …”

“…Despite guideline recommendations, access to HCV treatment has been frequently restricted because of the high DAA drug costs and prior authorization policies in which only the sicker get treated, slowing the expected rise in treatment rates . This delay in potentially curative treatment until development of advanced liver disease may have costly consequences …”

Real‐world effectiveness of 8‐week glecaprevir/pibrentasvir (G/P) for treatment naive, noncirrhotic patients with HCV infection in the TRIO network

“…Delaying HCV treatment can impact disease progression to cirrhosis, hepatocellular carcinoma, liver‐transplant and liver‐related death. It is possible to significantly reduce this clinical and economic burden through viral eradication, especially if treatment is initiated early and not delayed until fibrosis advances …”

Direct acting antivirals for patients without advanced liver disease: All for treatment and treatment for all?

“…A recent study showed a high burden of HCV-associated extrahepatic diseases (EHDs) and a decrease in all-cause medical costs post-SVR, which was largely attributed to decreased EHD-related spending. (8) It is therefore possible that the survival benefit noted in the current study was partially mediated through diminished chronic inflammation.…”