Association of Direct-Acting Antiviral Therapy for Hepatitis C With After-Treatment Costs Among Medicare Beneficiaries
Authors: Jeah Jung, Roger Feldman, Yamini Kalidindi, Thomas Riley
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Direct-acting antiviral (DAA) therapy for hepatitis C is highly effective but expensive. Evidence is scarce on whether DAA therapy reduces downstream medical costs. <h3>Objective</h3> To examine the association of DAA therapy with posttreatment medical costs among Medicare beneficiaries. <h3>Design, Setting, and Participants</h3> This retrospective cohort study obtained data from various Medicare claims files for 2013 to 2017. The study population comprised patients with a hepatitis C diagnosis in 2014 who were enrolled in fee-for-service Medicare and Part D. Multivariate regression models were used to compare changes in medical costs over a 30-month posttreatment follow-up period between patients who used DAA therapy (treatment group) and a propensity score–matched cohort of patients who did not use DAA (control group). The model was estimated separately for patients with and those without cirrhosis. Data were analyzed between September 1, 2019, and March 31, 2020. <h3>Exposures</h3> Completion of DAA therapy. <h3>Main Outcomes and Measures</h3> Two outcomes were established: hepatitis C or liver disease–related costs and total medical costs. Costs were measured by Medicare-allowed payments, which included Medicare reimbursements, patient responsibilities, and third-party payments. <h3>Results</h3> A propensity score–matched cohort of 15 198 patients (9038 men [59.5%]; mean [SD] age, 60.2 [10.8] years) was analyzed. During the first 6 months after DAA therapy, hepatitis C or liver disease–related costs decreased by $2498 (95% CI, −$3356 to −$1640) in patients with cirrhosis and by $486 (95% CI, −$603 to −$369) in patients without cirrhosis compared with control or untreated patients. Cumulative reductions in hepatitis C or liver disease–related costs during 30 months after DAA treatment were $15 808 (95% CI, −$22 530 to −$9085) in patients with cirrhosis and $5372 (95% CI, −$6384 to −$4360) in patients without cirrhosis. Among those who used DAA therapy compared with control patients, total medical costs decreased by $2905 (95% CI, −$4832 to −$979) in patients with cirrhosis and by $1287 (95% CI, −$2393 to −$283) in patients without cirrhosis during the first 6 months after DAA therapy. No statistically significant association was found between DAA therapy and total medical cost reductions after 12 months of follow-up. Cumulative reductions in total costs during 30 months after DAA therapy were $7074 (95% CI, −$18 448 to $4298) in patients with cirrhosis and $7497 (95% CI, −$14 287 to −$709) in patients without cirrhosis. <h3>Conclusions and Relevance</h3> This study reported that DAA therapy appeared to be associated with a decrease in hepatitis C or liver disease–related costs for 30 months after treatment and with reduction in total medical costs for only 12 months after treatment in patients with or without cirrhosis. Longer-term follow-up studies with diverse outcomes are necessary to assess the value of DAA therapy.