title: Treating Medicaid patients with hepatitis C: clinical and economic impact.
abstract: OBJECTIVE
  To estimate change in chronic hepatitis C virus (HCV) disease and the economic burden associated with comprehensive treatment of the chronic HCV-infected Medicaid population.
  
  
  METHODS
  Decision-analytic Markov model.
  
  
  METHODS
  Treatment-naïve patients with genotype 1 chronic HCV were followed over a lifetime horizon from the third-party payer perspective. Patients entered the model insured under Medicaid and were treated under state-specific restrictions by Metavir fibrosis stage (base case) or all treated (all-patient strategy) with an approved all-oral regimen (ledipasvir/sofosbuvir [LDV/SOF] for 8 weeks or 12 weeks, depending on cirrhosis status, viral load, and state-specific LDV/SOF restrictions). Untreated patients were assumed to age into Medicare at 65 years, where they were treated with LDV/SOF without restriction by fibrotic stage.
  
  
  RESULTS
  The sustained virologic response (SVR) rate of the current Medicaid LDV/SOF restriction strategy was 75.2% versus 95.9% if all LDV/SOF-eligible patients were treated under Medicaid. Treating all eligible Medicaid patients with LDV/SOF, regardless of fibrotic stage, was projected to result in 36,752 fewer cases of cirrhosis; 1739 fewer liver transplants; 8169 fewer cases of hepatocellular carcinoma; 16,173 fewer HCV-related deaths; 0.84 additional life-years per patient; and 1.03 additional quality-adjusted life-years per patient. Treating all Medicaid patients with chronic HCV using LDV/SOF resulted in a 39.4% ($3.8 billion) savings and decreased the proportion of total costs attributable to downstream costs of care to 18.3%.
  
  
  CONCLUSIONS
  A "treat all" strategy in a Medicaid population resulted in superior SVRs, substantial reductions in downstream negative clinical outcomes, and considerable cost savings. Current restrictive state policies regarding HCV treatment in Medicaid populations must be reassessed in light of these data.
authors.affiliation: Beatty Center for Integrated Research, 3300 Gallows Rd, Falls Church, VA 22042. E-mail: zobair.younossi@inova.org.
authors.forename: Zobair
authors.initials: Z
authors.lastname: Younossi
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Douglas
authors.initials: D
authors.lastname: Dieterich
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Rachel
authors.initials: R
authors.lastname: Beckerman
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000191:economics*; D001562:Benzimidazoles / Q000191:economics*; D005260:Female; D005449:Fluorenes / Q000191:economics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008390:Markov Chains; D008484:Medicaid / Q000191:economics*; D019057:Quality-Adjusted Life Years; D000069474:Sofosbuvir; D016896:Treatment Outcome; D014481:United States; D014542:Uridine Monophosphate / Q000031:analogs & derivatives* / Q000191:economics; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D001562:Benzimidazoles; D005449:Fluorenes; C000595958:ledipasvir, sofosbuvir drug combination; D014542:Uridine Monophosphate; D000069474:Sofosbuvir