Sobriety restrictions on hepatitis C treatment raise healthcare costs
People insured through state Medicaid programs more likely to be hospitalized
People with hepatitis C in the U.S. who are insured through state Medicaid programs that require them to be sober to access treatment are more likely to be hospitalized and tend to rack up higher healthcare-related costs, a new analysis demonstrates.
“Restricting [hepatitis C treatment] access in the vulnerable Medicaid population with HCV [hepatitis C virus] may be associated with adverse [healthcare resource utilization] consequences and higher healthcare costs, which may potentially impede [the World Health Organization]’s 2030 global hepatitis elimination goals,” the researchers wrote.
The data support abolishing such restrictions on hepatitis C treatment, the scientists said. Their study, “Health Care Resource Utilization and Costs Associated with US Medicaid Sobriety Restrictions on Direct-Acting Antivirals for Hepatitis C Virus: A Retrospective Claims Database Analysis,” was published in PharmacoEconomics. It was funded by Gilead Sciences, which markets several hepatitis C treatments.
Hepatitis C is a viral infection that causes liver inflammation. The disease-causing hepatitis C virus is spread by contact with blood and bodily fluids. In the U.S., it’s most often spread by sharing contaminated needles or other paraphernalia for injecting recreational drugs.
Direct-acting antivirals (DAAs) can stop HCV from growing. Representing the modern standard of care for hepatitis C, the therapies are effective for curing the infection in up to 95% of cases. However, “access to DAA treatments remains elusive for a significant proportion of individuals that suffer from HCV who have [additional] substance use disorders,” the researchers wrote.
Medicaid is a U.S. government-funded program that provides health insurance to low-income people. The researchers noted that studies suggest hepatitis C rates are “7.5 times higher” among people who rely on Medicaid, which is administered separately by each state, some of which have so-called sobriety restrictions that mandate that people with hepatitis C can only access DAA treatment if they’re not using alcohol or recreational drugs.
Sobriety restrictions and healthcare costs
Research suggests that health outcomes after DAA treatment aren’t substantially different between states that do or don’t have these restrictions. Here, scientists investigated how these programs affect the use of healthcare resources and healthcare costs and analyzed data from 2,295 people with hepatitis C who lived in states with sobriety restrictions and 4,623 from states without restrictions. All were insured by Medicaid and treated with DAAs in 2021.
Statistical analyses adjusted for potential influencing factors showed that hepatitis C patients living in states with sobriety restrictions were two times more likely to have an overnight stay in the hospital than those from states without sobriety restrictions, a significant difference. DAA initiators in states with sobriety restrictions also were 52% more likely to have an outpatient visit.
Patients in states with sobriety restrictions had a significantly higher risk of a hospitalization (2.5 times), outpatient visit (by 84%), and emergency department visit (by 57%), further analyses showed. Moreover, hepatitis C patients in states with sobriety restrictions accrued significantly higher costs associated with their healthcare than those in states without such restrictions (average, $63,935 vs. $41,524 per patient).
“Our analysis revealed that the [group] of DAA initiators in states with sobriety restriction versus states with no sobriety restrictions had a greater proportion of patients with [healthcare resource utilization] for the different types of healthcare settings in this analysis; a higher number of all-cause hospitalizations, [emergency department] visits, and [outpatient] visits; and greater all-cause healthcare costs,” the researchers wrote.
A likely explanation, according to the researchers, is that patients who have to wait to get DAAs are more likely to develop more serious disease, which means they end up needing more intensive, costly care by the time they access treatment. Other factors, such as requirements for drug abuse treatment, may also factor into the cost differences. The findings “suggest that sobriety restrictions can hinder efforts to eliminate HCV,” wrote the scientists, who called on states to remove restrictions to hepatitis C treatment for people insured through Medicaid.
“Removing these restrictions would improve access to DAAs, improve work toward [hepatitis C] elimination, and may serve a vital role in improving clinical outcomes and reducing economic burden on the healthcare system,” they wrote.
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