Timely hepatitis C screening helps US patients avoid costly illness
Investing in early treatment saves thousands in healthcare expenses over time
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Investing in hepatitis C testing and treatment may actually lower healthcare costs over time, according to a new study from Washington state.
By catching the virus early in healthy, asymptomatic individuals, the healthcare system avoids the high expenses associated with advanced liver disease and chronic complications.
Researchers analyzed the impact of a 2018 statewide initiative designed to expand access to screening and affordable medication. The findings suggest that, while more people were treated, the average cost per patient dropped significantly once the program fully took effect.
Results showed that, despite the increase in the number of people treated for hepatitis C in the years immediately after the intervention, the average non-medication cost per patient was lower in 2021 than before the initiative was implemented.
Shifting the focus to preventive care
“As an observational study, we cannot directly attribute the changes over time to the state initiative,” Pamela Kohler, PhD, the study’s senior author at the University of Washington, said in a university news story. “However, it does support the idea that investing in screening and treatment of healthy people without symptoms is more cost-effective than waiting until they become sick.”
The study, “Trends in Utilization and Costs Following a Hepatitis C Elimination Initiative,” was published in JAMA Network Open.
The hepatitis C virus (HCV) is spread by contact with bodily fluids and infects the liver, causing liver inflammation or hepatitis. Available treatments can cure hepatitis C in most cases, but patients can receive treatment only if they are first tested and accurately diagnosed.
In 2018, then-governor of Washington Jay Inslee signed a directive to improve care for people infected with hepatitis C. In addition to efforts to improve screening, the program included new infrastructure to increase coordination among public health agencies and a new structure to make treatments more affordable.
“The first-in-the-nation plan called for coordination between public health agencies, increased screening, removal of barriers to care and a new approach to purchasing antiviral medications at a discount,” the news story stated.
Investing in screening and treatment of healthy people without symptoms is more cost-effective than waiting until they become sick.
In the study, a team of researchers analyzed insurance data from more than 21 million people in Washington (about 70% of all residents) to understand how this directive affected care and associated costs.
“Comprehensive health insurance claims data can help us see how patterns in testing, treatment and healthcare costs are changing over time across a large population,” said Ashley Tabah, PhD, who worked on the study during her doctoral training at the University of Washington. “That kind of information can help states better understand how initiatives to expand access to care may affect both patients and the healthcare system.”
Data showed that from 2017 until about mid-2020, the median number of HCV tests per month remained generally stable at more than 24,000. As the initiative got rolling, this number increased significantly to about 99,000 in July 2020, and by the following year, the median number of tests had leveled off at nearly 56,000.
These trends were consistent with new national guidelines that recommended all adults undergo at least one HCV test, the team noted.
The increase in testing rates was accompanied by an immediate uptick in the number of new prescriptions for antiviral treatments after implementation. There was also an initial increase in the median number of chronic hepatitis C cases, followed by a significant reduction over time as more patients received treatment. In contrast, newly diagnosed cases showed a gradual decline both before and after the implementation.
Lowering costs through early intervention
The researchers then looked at costs related to hepatitis C care, evaluating all healthcare costs except for the direct costs of antiviral medications. Results showed that, in the years just before the initiative, average monthly healthcare costs related to hepatitis C increased from $45.6 million in 2017 to $70.8 million in 2019.
The researchers said this rise was likely attributable to an increase in Washington’s population during these years, resulting in more people to test and, in turn, a greater likelihood of treatment.
However, as the initiative got underway in 2020, even as the total number of people tested and treated increased or remained high, the average monthly costs related to hepatitis C decreased to $58.6 million in 2021.
“While total HCV care costs rose, costs per patient declined by more than 45%,” the news story stated.
Looking at the cost per individual receiving care, data showed a steady decrease over time: from 2019 to 2021, the average cost to treat each person with hepatitis C decreased by more than $500, the data indicated.
“Average health care costs (excluding HCV medication costs) per ever-prevalent patient with HCV have declined since about 1 year after the start of the contract compared with precontract trends,” the researchers wrote. “This decline may be due to increased screening and detection of infections in otherwise healthy individuals, with improved curative outcomes and fewer [co-occurring health conditions] over time.”
