Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Lifetime medical costs of chronic hepatitis C in the United States.”
What question(s) does this study address?
If untreated, chronic Hepatitis C virus (HCV) infection can lead to progressive liver damage resulting in cirrhosis, liver cancer, and death. One analysis estimated that 20-30% of persons with untreated chronic HCV infection will progress to cirrhosis over a period of 25-30 years. All oral, direct acting antiviral drugs (DAAs) that can cure HCV infection have been available in the U.S. since 2014, yet people are still dying from HCV infection. The U.S. Centers for Disease Control and Prevention (CDC) reported 11,194 deaths in 2023 related to HCV disease. In addition to its toll in human suffering, disease progression among persons with undiagnosed and untreated HCV infection can result in substantial health care costs.
Abimbola and her colleagues estimated the lifetime direct medical costs of chronic HCV infection by disease stage (non-cirrhosis, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and post liver transplant) using medical and laboratory claims data and a Markov transition model. Their analysis considered costs separately for persons treated with DAAs and those persons who were untreated. Their hypothetical cohort consisted of 2,228,000 U.S. adults aged 18 years and older with chronic HCV infection in 2020.
What are the major findings of this report/article?
- For a hypothetical cohort of 2.228 million persons with chronic HCV infection the projected total medical costs were estimated to be $200 billion dollars if all were treated with DAAs and $347 billion if all were untreated. Higher HCV prevalence estimates resulted in larger total medical costs. For example, if HCV prevalence was as high as 4 million adults, the overall medical cost burden was estimated at $364 billion for treated and $630 billion for untreated.
- Estimated medical costs, per person, varied by disease state but overall, the per person lifetime medical cost was $90,089 for those treated versus $155,930 for the untreated.
- The model demonstrated a substantial reduction in the overall lifetime medical costs of Hepatitis C for persons treated with DAAs compared to untreated persons.
What are the implications for the prevention and control of viral hepatitis?
- A number of obstacles must be overcome in order to eliminate hepatitis C virus infection in the U.S., but chief among them is the need for greatly expanded HCV diagnosis and treatment.
- Consistent with the findings of this model, a 2024 analysis conducted by the Congressional Budget Office (CBO) concluded that expanded Hepatitis C treatment would lead to reductions in per-person spending on health care and that the health care savings “would more than offset direct spending on that treatment.”
- Mobilizing the political will to provide adequate federal resources for a national HCV elimination program will require that legislators come to understand that the societal benefits of eliminating HCV in the U.S. will unfold in a time frame that extends well beyond a single budget cycle and recognize that these benefits aren’t limited to the health care sector, but will also accrue to other sectors, resulting in increased workforce productivity, improved social well-being, and enhanced quality of life.
