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HCV Treatment, HIV Treatment: public & personal health denied - HCV Cost Burden - commentary
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"Are the state medicaids over inflating the cost burden of treating HCV, only 70,000 have been treated with Sovaldi this year, that's not a lot and then divide it by 50 states, but medicaids are claiming their projections of the impact of treating HCV is straining their budgets, perhaps they are over estimating the numbers they might be treated plus we know that it takes years to treat the total patient population, they all can't be treated within one or two years, and 50-75% are undiagnosed. Many observers feel medicaids are trying to push back having to pay for treatment hoping that a large number of eligible patients will age into Medicare."
......some payers (medicaid) are constructing unconscionable criteria to prevent access to treatment including Oregon & Illinois......in a published study below healthcare costs in 30 managed care organizations for HCV+ patients was 4 times that of individuals in the healthcare system without HCV: 'HCV costs 4 times control group, SVR reduced costs'
Jules Levin, NATAP
A number of state medicaids and commercial payers have been complaining about the cost of new HCV drugs. We must save them from themselves, lol. Don't they realize how much NOT treating HCV will cost them. They are akin to terrorists by using HCV patients as hostages for a false battle they are fighting over the price of HCV drugs. Do you really trust commercial health insurance companies when they say they can't afford to pay for HCV treatment? These are the guys who are public companies who have to answer to Wall St & the markets every quarter to show a profit to make their shareholders happy & please the markets so their stock price goes up. Access to our healthcare is now subject to these criteria. These are the guys that incessantly pushed mail-order pharmacy for HIV medications despite that patients hated it, they refused to stop, the horrible inconvenience it created for many, it broke anonymity, it could get stolen or lost upon due to uncertain delivery, and United HealthCare agreed to allow optout recently only after part of agreeing to settle a lawsuit. We cannot afford not to treat HCV, treating HCV is less costly than not treating HCV as my report below is demonstrated by the data. As well medicaid's get a serious discount of 23% off drug prices which is negotiable to the 44% discount the VA gets, so are we to have sympathy for them, if they continue to deny life-saving HCV therapy. The medicaid law requires in return for this discount medicaids are required to provide treatment, not permitted to deny access, they are breaking the law. Some of them are implementing severe criteria to limit access: allowing treatment only for patients with seriously advanced disease, F3/F4, cirrhosis, which increases risk for liver cancer, HCC, or ruling that if a patient has not been clean from using drugs for 12 months they can't be treated, thats absurd because injection drug use is the leading cause of HCV transmission, this would be a joke if it wasn't a serious effort to deny life. This is only some, many state medicaids are paying for the new HCV drugs right now, NYS is paying for the new drugs, but recently states constructing unconscionable barriers include Oregon, Illinois, and Florida. Drug users can & should be treated, HCV is a public health epidemic, it can be eradicated, we could save billions but the payers worry about this quarter, this year's budget, lol. Even United Health Care's PBM Optum agrees hcv treatment is cost effective....http://www.natap.org/2014/HCV/062514_07.htm. Public & private payers, medicaid, commercial insurance companies, complain the cost of HCV drugs will bust "this year's budget". Well hello, what about the longer term cost of not treating HCV. Projected HCV associated healthcare costs are estimated to be $9-85 billion over the next 10-20 years, the old Millman report says: "Total medical costs for patients with HCV infection are expected to increase more than 2.5 times, from $30 billion to over $85 billion over the next 20 years."....."Medicare will bear responsibility for a growing portion of patients with chronic HCV infection - increasing from 12% to 39% in 2028."....http://www.natap.org/2009/HCV/051809_01.htm. Many observers say the strategy by medicaid & commercial payers is if they can delay treatment patients with HCV then they can dump it all onto Medicare. First, it is unacceptable that patients should be denied access to HCV treatment. Payers & the federal govt need to sit down & figure this out. The CDC & the NIH with The White House & Congress should open hearings and examine the private & public payers & figure out a way to stop denying healthcare including HCV treatment because of their claims that this year's budget can't take it. It appears they are overestimating the number of HCV patients that could be treated in a year, to hoodwink the public. Only 70,000 were treated with Sovaldi this year, it takes time to treat patients, they flow through the treatment process much more slowly than they claim, the HCV patients will not be treated at once, this will be spaced out over years. But once we treat most patients they costs will precipitously go down & the immense long term costs projected into the multiple billions will be gone. So perhaps we need a new model for funding healthcare that can look out over a long term of 10-20 years rather than by quarter....http://www.natap.org/2014/HCV/080614_02.htm......Aside from the numbers that show the cost/benefit ratio in dollars favors treating HCV, there was an article published recently in the journal Hepatology written by 2 leading HCV researchers from Chicago Don Jensen & Nancy Reau reviewing the costs & benefits of HCV treatment and concluded HCV SVR (cure) is priceless....http://www.natap.org/2014/HCV/020714_02.htm.
Domestically in the USA the federal govt spends $22 billion a year on HIV, $5 bill for medicaid, $5 bill for medicare. Yet insurance companies are paying for this in general, except recently some used the new ACA as an excuse to impose severe limitations to patients access to HIV treatment, which is clearly a violation of the letter or the spirit of the ACA law & they will be challenged. The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars). The average annual cost of HIV care in the ART era was estimated to be $19,912 (in 2006 dollars; $23,000 in 2010 dollars).. The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars). But over the cost of a lifetime actual care costs including HAART can be over $1 million. Take a look at HCV costs: In 2011, the total healthcare cost associated with HCV infection was $6.5 ($4.3-$8.2) billion.......Total cost is expected to peak in 2024 at $9.1 billion ($6.4-$13.3 billion), as shown in Figure 3. The majority of peak cost will be attributable to more advanced liver diseases-decompensated cirrhosis (46%), compensated cirrhosis (20%), and hepatocellular carcinoma (16%). The maximum cost associated with mild to moderate fibrosis (F0-F3) occurred in 2007 at nearly $780 million. The cost associated with compensated cirrhosis is expected to peak in 2022 at $1.9 billion, while the peak cost for decompensated cirrhosis and HCC is predicted to occur in 2025, with annual costs in excess of $4.2 billion and $1.4 billion respectively.".........the "incidence of more advanced liver diseases will continue to increase, with incidence of decompensated cirrhosis and HCC peaking in 2016-2017......by 2030, compensated cirrhosis cases will account for 37% of all prevalent cases. The HCV compensated cirrhotic population is projected to peak in 2015, while the decompensated cirrhotic population will peak in 2019"......"The effects of new therapies were excluded from our model. However, if the number of treated patients is doubled and kept constant at 126,000 per year in 2012-2030 and the average SVR is increased to 70%, the 2030 prevalent population is projected to be less than 100,000 cases. This illustrates that it is possible to substantially reduce HCV infection in the US through active management."....... http://www.natap.org/2013/HCV/010713_01.htm......Hepatology Accepted Article Dec 22 2012, H. Razavi
[Averaging over all CD4 strata, the mean annual total expenditures per person for HIV care in 2006 in three sites was US $19 912, with an interquartile range from US $11 045 to 22 626. Average annual per-person expenditures for care were greatest for those with CD4 cell counts 50 cell/μl or less (US $40 678) and lowest for those with CD4 cell counts more than 500 cells/μl (US $16 614). The majority of costs were attributable to medications, except for those with CD4 cell counts 50 cells/μl or less, for whom inpatient costs were highest.
Gebo KA, Fleishman JA, Conviser R, Hellinger J, Hellinger FJ, Josephs JS, Keiser P, Gaist P, Moore RD; HIV Research Network. Contemporary costs of HIV healthcare in the HAART era. AIDS 2010; 24(17): 2705-2715.]
Our study provides current estimates of the direct economic burden of chronic HCV infection to MCOs (30 managed care organizations for this study), our study sample was derived from a largely employed population enrolled in a commercial managed care health plan. Findings from this study suggest that chronic HCV is an important and potentially costly disease to MCOs and confirms earlier expectations of cost growth associated with the disease. Additional study is also needed to assess the cost implications of HCV in other markets outside of the United States where disease prevalence is higher:
Direct Economic Burden of Chronic Hepatitis C Virus in a United States Managed Care Population: 'HCV costs 4 times control group, SVR reduced costs'....."Disease-related costs in HCV exceed all-cause costs in demographically matched controls......annual per patient cost burden to payers for chronic HCV exceeds that of other more common conditions such as cardiovascular disease ($18,953)27 and type 2 diabetes ($9677)......Adjusted all-cause costs were $20,961 per HCV patient, compared with $5451 per control......patients who achieved SVR incurred approximately half the HCV-related costs per month incurred by those who did not achieve SVR ($717 vs. $1436; P<0.0001)" .......http://www.natap.org/2013/HCV/040513_01.htm.......Journal of Clinical Gastroenterology: February 2011
"Increased efforts in HCV screening and early treatment, particularly before progression to liver cirrhosis, may lead to long-term cost savings in HCV management for managed care systems.....With the combined aging of the HCV population and the increasing costs for treatment, the economic burden of chronic HCV infection is expected to grow proportionally with its clinical burden over the next 10 to 20 years......Wong et al17 estimated that total direct medical expenditures attributable to chronic HCV in the United States between 2010 and 2019 will be $10.7 billion. Over this same period in the United States, it was also estimated that decompensated cirrhosis and hepatocellular carcinoma will lead to 720,000 life years lost and $21.3 billion in related societal costs, whereas the indirect costs attributable to HCV-related deaths in persons younger than 65 years are projected to be $54.2 billion.".........
"Data were extracted from the Integrated Health Care Information Services (IHCIS) Managed Care Benchmark Database, a commercially available source of administrative medical and pharmacy claims data, and member enrollment information, from 30 managed care organizations (MCOs) across the United States......At the time of this study, the IHCIS database included more than 50 million unique lives from 2000 to 2006. The IHCIS database comprises separate files for inpatient stays, medical claims, pharmacy claims, and health plan enrollment. Laboratory test results also are available for a small subset of patients enrolled in plans that allow submission of laboratory values to IHCIS. To assess the increased all-cause health care utilization and costs associated with chronic HCV, we also selected a demographically matched control group without a diagnosis of HCV. Patients in the control group met all inclusion criteria applied to the HCV case group. The control group was matched to HCV cases at a 1:1 ratio on age (±3 y), sex, and length of health plan enrollment. Controls were assigned the same index date identified for their matched counterparts in the HCV case group."
"Compared with controls, HCV patients had substantially higher use and associated costs for all service categories." Adjusted all-cause costs were $20,961 per HCV patient, compared with $5451 per control......patients who achieved SVR incurred approximately half the HCV-related costs per month incurred by those who did not achieve SVR ($717 vs. $1436; P<0.0001)."
"Key cost drivers among HCV patients were prescription drugs ($6191) and hospitalizations ($5892)........During the minimum 6-month period after the end of treatment and SVR assessment, patients who achieved SVR incurred approximately half the HCV-related costs per month incurred by those who did not achieve SVR ($717 vs. $1436; P<0.0001)"
"Our study provides current estimates of the direct economic burden of chronic HCV infection to MCOs.....total annual per patient costs of $20,961 estimated in this study. Our study findings thus support earlier predictions that the economic burden of HCV will continue to grow as a result of an aging cohort living with the disease and will be borne increasingly by commercial insurance providers.15,16 Our findings also confirm that the annual per patient cost burden to payers for chronic HCV exceeds that of other more common conditions such as cardiovascular disease ($18,953)27 and type 2 diabetes ($9677)"
"......chronic HCV is an important and potentially costly disease to MCOs and confirms earlier expectations of cost growth associated with the disease. Increased efforts in HCV screening and early treatment, particularly before progression to liver cirrhosis, may therefore, lead to substantial cost savings for MCOs."
Health Care Utilization and Costs-HCV
Versus Control
Figure 1 shows the percentage of patients with use of each category of all-cause health care utilization during the 12-month follow-up period. Among HCV cases, the percentage with disease-specific utilization is also presented. Compared with controls, a higher proportion of patients with HCV had at least 1 claim in every all-cause utilization category examined. The largest differences in the percentage of patients with use were observed for hospitalizations (24% of HCV cases vs. 7% of controls; P<0.0001), emergency room visits (32% vs. 15%; P<0.0001), and laboratory tests (79% vs. 35%; P<0.0001). Among those with HCV, 14%had at least 1 disease-related hospitalization.
Table 2 presents the volume of use and associated costs of each service category. Among patients in the HCV case group, all-cause utilization and costs were subset to those directly attributable to HCV. Compared with controls, HCV patients had substantially higher use and associated costs for all service categories. Adjusted total all-cause costs incurred during the 12-month follow-up period were $20,961 per patient among HCV cases compared with $5451 among controls (P<0.0001). Key cost drivers among HCV patients were prescription drugs ($6191) and hospitalizations ($5892). In contrast, the control group incurred only $1315 and $1159 per patient for pharmacy and hospital services, respectively (P<0.0001). Although HCV patients received, on average, only 2 disease-related prescriptions during follow-up (reflecting a low treatment rate in the population studied), HCV-related drugs accounted for more than half of their prescription drug costs. Overall, disease-related resource use accounted for nearly one-third of all costs incurred by patients with HCV. Disease-related costs in the HCV group were $6864, which exceeded all-cause costs observed for controls by 26% (P<0.0001). This difference was driven primarily by disease-related hospitalization and pharmacy
costs in patients with HCV ($2078 and $3433, respectively), which exceeded all-cause hospitalization and pharmacy costs in controls ($1159 and $1315, respectively) by 79% and 161%, respectively (all P<0.0001).
HCV Treatment Cost-Effective Unitedhealthcare's OPTUMRx PBM
says......http://www.natap.org/2014/HCV/062514_07.htm
New Models for Healthcare Funding
Needed.......http://www.natap.org/2014/HCV/080614_02.htm
HCV Cures Result in Long-Term Savings & Improved Quality of
Life.......http://www.natap.org/2014/HCV/062514_03.htm
Sticker Shock and the Price of New Therapies for Hepatitis C: Is it worth it? "SVR is arguably
priceless"......http://www.natap.org/2014/HCV/020714_02.htm
HCV Treatment Costs Benefit/Cost
Ratio..........http://www.natap.org/2014/HCV/021914_02.htm
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