Objectives: The new direct-acting antivirals (DAAs), introduced at the end of 2013, are effective in treating chronic hepatitis C virus (HCV) infection, but they may represent a substantial financial burden on patients and health insurers. We examine the use and costs of HCV medications in a commercially insured population.
study design: retrospective cohort study.
Methods: We used claims data from 3,091 people with HCV infection (2012-2015). Outcomes included HCV medication use, inflation-adjusted out-of-pocket (OOP) and health plan expenses, and predictors of receiving new DAAs.
See also: COBRA continuation coverage | ERS
Findings: Cumulatively, 9% of members with an HCV diagnosis were treated with HCV medications in 2012 and this increased to 32% in 2015. Of 3,091, 589 received new DAAs and 80% (n=465) completed a 12-week treatment regimen. After the new DAAS became available, the average annual health plan spend on HCV medications increased from $2,869 to $16,504 per member diagnosed with HCV (relative change, 475%; 95% CI, 352%-598%) and operating expense expense increased from $41 to $94 (relative change, 131%; 95% ci, 15%-247%). age (between 50 and 64 years [adjusted odds ratio (aor), 2.13; 95% CI, 1.29-3.53] and ≥65 years [aor, 2.01; 95% CI, 1.14- 3.55] compared to being <30 years old) and having liver cirrhosis (aor, 3.34; 95% CI, 2.64-4.21) were positively associated with receiving new DAAs, and a diagnosis of substance abuse. alcohol (aor, 0.70; 95% ic, 0.53-0.92) was negatively associated with receiving new daas.
Conclusions: The proportion of a commercially insured population with HCV infection who was treated with HCV medications doubled within 2 years after the availability of new DAAs. Member expenses were kept low, while the health plan covered 99% of the cost of HCV medications. During our 2-year follow-up, we did not observe any financial benefit to the health plan from the cure of HCV infection from new DAAs.