Control Hepatitis C Early, Cut Costs

Hepatitis C is expected to ravage the livers of millions of Americans and cost the healthcare industry billions of dollars to treat in the coming years, but a new study by the Oakland-based Kaiser Permanente suggests controlling the chronic condition early can dramatically reduce costs.

Hepatitis C affects about 4 million Americans, including at least 600,000 Californians, according to the state’s Hepatitis C Task Force.

The disease is typically connected with being HIV positive, having a history of intravenous drug use, or undergoing an organ transplant prior to the early 1990s. It is close to endemic in some prison populations.

However, there are few symptoms of the disease until it is relatively late in its progression. Healthcare researchers believe the cost of treating the disease will soar in the next decade because millions more Americans will reach the advanced stage of hepatitis C and will be diagnosed with the disease.

In the advanced stages of hepatitis C, a liver transplant – one of the most expensive surgeries to perform – is among the few ways to stem the progression of the disease in a patient where the virus is not under control.

Kaiser's Northern California division examined the care given to 1,924 hepatitis C patients between 2002 and 2007 who had undergone anti-hepatitis drug therapy. 

About half of those patients received care relatively early on in the progression of their disease and were able to achieve what is known as sustained virologic response – no detection of the hepatitis virus in their blood for at least six months after the completion of their therapy.

Among those patients who had achieved the SVR state, their post-treatment costs per year averaged $6,301. 

By comparison, the costs for the non-SVR group post-treatment averaged $10,149 a year.

The higher costs were connected to more frequent laboratory testing, which was as much as 80% higher in some cases compared to the non-SVR population. Physician visits, particularly to specialists such as gastroenterologists, were up to 40% higher. Hospitalizations were up to 120% higher among some patients compared to those whos e virus was not under control.

Altogether, the cost differential between those with the virus under control and those without control ranged from 26% to 64% higher, researchers conclided.

Kaiser’s cost information was extrapolated from myHealthConnect, its extensive electronic medical records system, officials said.

“The cost of caring for patients with hepatitis C increase as liver disease severity progresses,” said M. Michele Manos,  a senior investigator at Kaiser Permanente's Division of Research and director of its hepatitis registry. “Currently, we have the rapid introduction of novel HCV antivirals with increasingly greater success rates and higher costs. It’s essential to have a firm grasp of post-treatment cost savings — which are independent of therapy type — when estimating the overall cost-effectiveness of each of the new antiviral strategies.”

Manos also noted that given the slow progression of hepatitis C, the cost savings among those who have accomplished SVR may continue to grow compared to other populations, who often receive treatments for a decade or more before they can undergo a liver transplant.

The study's findings were published in the most recent issue of the Journal of Managed Care Pharmacy.