Promoting Access to Hepatitis C Treatment: Policies and their Impacts on Patients and Society

Background: Hepatitis C (HCV) is a disease that can be cured through a medication treatment known as Direct Acting Antivirals (DAA). The use of DAA medications is relatively low due to many patients being unaware that they have HCV and the high cost of the medication. In addition, the medications for many of the co-morbid conditions that are associated with HCV are underused. Objective: The objectives of the three studies were to: (1) estimate the impact of an HCV screening mandate on patient initiation of DAA treatment for HCV; (2) estimate the changes in medication adherence after initiation of DAA treatment for HCV; (3) estimate the budgetary impact of state-sponsored expanded coverage of DAAs to the Medicare program. Methods: The impact of the HCV screening mandate on DAA treatment initiation was estimated using a regression discontinuity design with Truven MarketScan outpatient and pharmacy claims data. A single interrupted time series model was used to measure the changes in medication adherence from before to after DAA initiation, using Truven MarketScan pharmacy claims data. The budget impact of expanded DAA coverage was estimated using a Markov model with univariate and probabilistic sensitivity analyses. Results: Patients who were mandated to be offered an HCV screening experienced increases of 5,885 per 100,000 in screening rates and 89 per 100,000 in treatment rates compared to non-mandated patients. Among patients who were influenced by the mandate to be screened (i.e., the local average treatment effect), DAA initiation rates increased by 764 per 100,000 compliers. Immediately after DAA initiation, patients demonstrated a higher odds of possessing medications that treat hypertension and depression, but these possession probabilities decreased over the course of the post-DAA initiation period. State-sponsored expanded coverage would have an average incremental cost increase of $1.97 per-taxpayer-per-year. Conclusion: Screening mandates can be effective in increasing use of DAA medications. Initiation of DAA medications is associated with modest increases in medication possession probabilities for hypertension and depression, but these increases are temporary. The budgetary impact of state-sponsored expanded DAA coverage is relatively modest compared to the health benefits that would result from this policy