VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Mail code L457, Portland, OR, 97239, USA.
Oregon Health and Sciences University, School of Medicine, Portland, OR, USA.
Dig Dis Sci. 2018 Jun;63(6):1454-1462. doi: 10.1007/s10620-018-4956-0. Epub 2018 Feb 16.
Approximately 233,898 individuals in the Veterans Affairs healthcare network are hepatitis C virus (HCV)-infected, making the Veterans Affairs the single largest provider of HCV care in the USA. Direct-acting antiviral treatment regimens for HCV offer high cure rates. However, these medications pose an enormous financial burden, and whether HCV cure is associated with decreased healthcare costs is poorly defined.
To measure downstream healthcare costs in a national population of HCV-infected patients up to 9 years post-HCV antiviral treatment, to compare downstream healthcare costs between cured and uncured patients, and to assess impact of cirrhosis status on cost differences.
This is a retrospective cohort study (2004-2014) of hepatitis C-infected patients who initiated antiviral treatment within the United States Veterans Affairs healthcare system October 2004-September 2013. We measured inpatient, outpatient, and pharmacy costs after HCV treatment.
For the entire cohort, cure was associated with mean cumulative cost savings in post-treatment years three-six, but no cost savings by post-treatment year nine. By post-treatment year nine, cure in cirrhosis patients was associated with a mean cumulative cost savings of $9474 (- 32,666 to 51,614) per patient, while cure in non-cirrhotic patients was associated with a mean cumulative cost excess of $2526 (- 12,211 to 7159) per patient.
Among patients with cirrhosis at baseline, cure is associated with absolute cost savings up to 9 years post-treatment compared to those without cure. Among patients without cirrhosis, early post-treatment cost savings are counterbalanced by higher costs in later years.
退伍军人事务部医疗网络中约有 233898 人感染丙型肝炎病毒（HCV），使其成为美国最大的 HCV 治疗服务提供商。直接作用抗病毒治疗方案可实现高治愈率。然而，这些药物带来了巨大的经济负担，HCV 治愈是否与降低医疗成本相关尚未明确。
在 HCV 抗病毒治疗后长达 9 年的时间内，测量全国 HCV 感染患者的后续医疗成本，比较治愈和未治愈患者的后续医疗成本，并评估肝硬化状态对成本差异的影响。
这是一项针对美国退伍军人事务部医疗系统中于 2004 年 10 月至 2013 年 9 月期间接受 HCV 抗病毒治疗的 HCV 感染患者的回顾性队列研究。我们测量了 HCV 治疗后的住院、门诊和药房费用。
对于整个队列，治愈与治疗后第 3 至 6 年的累计成本节约相关，但在治疗后第 9 年没有成本节约。对于肝硬化患者，治疗后第 9 年的治愈与每位患者平均累计成本节约 9474 美元（-32666 美元至 51614 美元）相关，而对于非肝硬化患者，治愈与每位患者平均累计成本超支 2526 美元（-12211 美元至 7159 美元）相关。
在基线时患有肝硬化的患者中，与未治愈的患者相比，治疗后 9 年内治愈与绝对成本节约相关。在无肝硬化的患者中，早期治疗后的成本节约被后期更高的成本所抵消。
