Background: Expenditures associated with untreated hepatitis C (HCV) and its complications impact state Medicaid budgets and should be quantified to inform reimbursement policies for HCV therapy. We determined the service utilization and costs associated with HCV with and without advanced liver disease (ALD) in Illinois Medicaid beneficiaries.
Methods: Population-based descriptive and retrospective case-control study using administrative data from the Illinois Medicaid fee-for-service program, 2006-2009. Cases were aged 18-64y with untreated HCV, stratified by presence or absence of ALD. Controls were uninfected patients, matched to cases based on age, sex, race, enrollment time, co-morbidity and geography characteristics. We calculated adjusted all-cause per-person per-month costs (PPPM), health service utilization including hospitalization, emergency room use, outpatient visits and receipt of long-term care, and unadjusted total 4-year all-cause expenditures.
Results: We identified 9,903 patients with untreated HCV infection, and matched 9,571 cases (96.6%) to 172,886 un-infected controls. The prevalence of HCV was 1.2%. HCV infection without and with ALD was associated with increased service utilization and cost compared to non-infected matched controls. Mean adjusted all-cause PPPM costs among persons with HCV and matched controls without HCV were $3,012 and $1,604, respectively (p < 0.001). In stratified analysis, costs for HCV cases without ALD were nearly twice that of non-infected controls ($2,222 vs $1,192, p <0.001). Costs for HCV cases with ALD compared to non-infected controls were likewise higher ($6,725 vs $3,521, p < 0.001). Cases with ALD comprised 24% of the HCV-infected population while accounting for 40% of total spending.
Conclusion: HCV and HCV-associated ALD generate substantial cost for IL Medicaid. Treating HCV before patients become cirrhotic could prevent substantial service utilization and costs.
M. T. Pho,
J. Salomon, None
E. Huang, None
R. Nocon, None
J. Morgan, None
L. White, None
B. Linas, None
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