March 30, 2020
In a recent study focused on measuring hepatitis C (HCV) treatment initiation rates between HCV monoinfected and HCV/HIV coinfected patients, researchers found that the coinfected group cost payers five times more in therapy expenditures.
Sascha van Boemmel-Wegmann, PhD, department of pharmaceutical outcomes and policy, University of Florida College of Pharmacy, Gainsville, FL, and colleagues, conducted a retrospective analysis of new diagnosed HCV patients in which they estimated the odds ratio of initiating HCV treatment during the pre- direct-acting antivirals (DAAs) and post-DAA periods. Kruskal-Wallis test was used to compare drug costs for dual, triple and all-oral therapies.
The researchers note that DAAs have proven high efficacy and safety but access has been restricted because of the high costs.
The analysis comprised 15,064 patients in the pre-DAA period (382 [2.5%] HIV coinfected) and 14,896 in the post-DAA period (429 [2.9%] HIV coinfected).
When examining HCV treatment uptake during the pre-DAA period, HCV/HIV coinfected patients had lower odds compared to the HCV monoinfected cohort [odds ratio, 0.59; 95% confidence interval (CI), 0.45-0.78]. There was little difference in the odds of HCV treatment uptake during the post-DAA period (OR, 1.08; 95% CI, 0.87-1.33).
Researchers note that the initiation rates increased but pointed out a substantial increase in costs for the HCV/HIV coinfected group.
Regarding costs, from 2009 to 2016, average payers' treatment costs (dual, $20,820; all-oral DAAs, $99,661; P<.001) as well as average patients' copayments (dual, $593; all-oral DAAs $933; P< .001) increased significantly.
“HCV treatment initiation rates increased, especially among HCV/HIV coinfected patients, from the pre-DAA to the post-DAA period,” Dr van Boemmel-Wegmann and colleagues concluded. “However, payers' expenditures per course of therapy saw an almost fivefold increase and patients' copayments increased by 55%.”
van Boemmel-Wegmann S, Lo Re V 3rd, Park H. Early treatment uptake and cost burden of hepatitis c therapies among newly diagnosed hepatitis c patients with a particular focus on HIV coinfection [published online ahead of print January 14, 2020]. Dig Dis Sci. 2020; doi:10.1007/s10620-019-06037-z