The burden of hepatitis C to the United States Medicare system in 2009: Descriptive and economic characteristics

Abstract

The aim of this work was to estimate and describe the Medicare beneficiaries diagnosed with hepatitis C virus (HCV) in 2009, incremental annual costs by disease stage, incremental total Medicare HCV payments in 2009 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data covering the years 2002 to 2009. We weighted the 2009 SEER-Medicare data to create estimates of the number of patients with an HCV diagnosis, used an inverse probability-weighted two-part, probit, and generalized linear model to estimate incremental per patient per month costs, and used simulation to estimate annual 2009 Medicare burden, presented in 2014 dollars. We summarized patient characteristics, diagnoses, and costs from SEER-Medicare files into a person-year panel data set. We estimated there were 407,786 patients with diagnosed HCV in 2009, of whom 61.4% had one or more comorbidities defined by the study. In 2009, 68% of patients were diagnosed with chronic HCV only, 9% with cirrhosis, 12% with decompensated cirrhosis (DCC), 2% with liver cancer, 2% with a history of transplant, and 8% who died. Annual costs for patients with chronic infection only and DCC were higher than the values used in many previous cost-effectiveness studies, and treatment of DCC accounted for 63.9% of total Medicare's HCV expenditures. Medicare paid $2.7 billion (credible interval: $0.7-$4.6 billion) in incremental costs for HCV in 2009. Conclusions: The costs of HCV to Medicare in 2009 were substantial and expected to increase over the next decade. Annual costs for patients with chronic infection only and DCC were higher than values used in many cost-effectiveness analyses. (HEPATOLOGY 2016;63:1135-1144 H epatitis C virus (HCV) is the most common blood-borne infection in the United States, with at least 2.7 million chronically infected Americans.(1) Current patients with HCV were primarily infected by behavioral and medical exposures between the 1960s and the early 1990s, and as a result, an estimated 70.1% of those HCV antibody positive were born during the years of 1945-1965. (2,3) In 2010, the first members of the 1945-1965 birth cohort became eligible for the U.S. Medicare program through the aged (age 65) eligibility pathway, and many more are likely to enter the program over the coming decades.To date, no paper has attempted to estimate either the per person costs or the aggregate health impact of HCV on the Medicare system, and the number of HCV patients seeking care in Medicare is unknown. This is an important knowledge gap because at least 1 million new chronically infected persons are likely to age into Medicare over the next 10-20 years. (3) Costs for HCV patients in Medicare may be different than in private insurance owing to their age, the high prevalence of other comorbidities, and differences in Medicare reimbursements compared to other payers. Finally, the need to offer treatment to patients before Medicare entry is in dispute. (4)

Estimation of direct medical cost related to the management of chronic hepatitis C and its complications in South Korea

“…However, our data might be used as a reference with which future cost studies on CHC would be compared. [12] Considering that the era of treatment with interferon-free direct-acting antivirals (DAAs) has begun for the management of CHC globally, [13] it might be relevant to draw such cost data in the last period for therapy with pegylated interferon.…”

“…Indeed, the costs for management of patients with DC are significant even in the United States, accounting for 63.9% of total Medicare's HCV expenditures. [12] …”

Potential epidemiologic, economic, and budgetary impacts of current rates of hepatitis C treatment in medicare and non‐medicare populations

“…The model includes three types of medical costs: medical management of diagnosed HCV, the costs of HCV treatment, and costs for treatment management and follow‐up. For Medicare patients, we assign annual medical management costs based on the calculation of overall medical costs attributable to HCV by stage using a two‐part log‐link “tpm” module in STATA on 2009 SEER/5% Medicare claims data, representing 407,786 Medicare beneficiaries 3, 15. Medical management costs for non‐Medicare‐insured patients are based on published estimates of attributable costs calculated for private payers 16.…”

Economic Burden of Hepatitis C Infection

“…61 In contrast, in the Medicare population, the greatest share of expenditures (64%) was owing to decompensated cirrhosis. 60 Among the sequelae of advanced liver disease caused by HCV, hepatocellular carcinoma, variceal hemorrhage, and refractory ascites were the most expensive, each exceeding $25,000 PPPY (2010 US dollars), 63 followed by hepatic encephalopathy ($17,800 per inpatient admission in 2009). 64 These studies of the total HCV burden cited were conducted before the era of DAAs, which could have potentially shifted the trajectory of both the costs and consequences of HCV infection.…”

“…Out of that, approximately $2.7 billion was covered by Medicare alone. 60 The most expensive state of health associated with HCV was the first year after liver transplantation, with different reports suggesting an average annual perpatient per-year (PPPY) expenses exceeding $140,000 in late 2000s. 61,62 Within the remainder of the spectrum of HCV-related liver disease, as reported from a large US health care management organization study, asymptomatic patients with HCV incurred approximately $6000 PPPY in incremental costs (in 2009 US dollars).…”