Department of Health Policy and Administration, The Pennsylvania State University College of Health and Human Development, University Park.
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
JAMA Netw Open. 2020 Jun 1;3(6):e208081. doi: 10.1001/jamanetworkopen.2020.8081.
Direct-acting antiviral (DAA) therapy for hepatitis C is highly effective but expensive. Evidence is scarce on whether DAA therapy reduces downstream medical costs.
To examine the association of DAA therapy with posttreatment medical costs among Medicare beneficiaries.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study obtained data from various Medicare claims files for 2013 to 2017. The study population comprised patients with a hepatitis C diagnosis in 2014 who were enrolled in fee-for-service Medicare and Part D. Multivariate regression models were used to compare changes in medical costs over a 30-month posttreatment follow-up period between patients who used DAA therapy (treatment group) and a propensity score-matched cohort of patients who did not use DAA (control group). The model was estimated separately for patients with and those without cirrhosis. Data were analyzed between September 1, 2019, and March 31, 2020.
Completion of DAA therapy.
Two outcomes were established: hepatitis C or liver disease-related costs and total medical costs. Costs were measured by Medicare-allowed payments, which included Medicare reimbursements, patient responsibilities, and third-party payments.
A propensity score-matched cohort of 15 198 patients (9038 men [59.5%]; mean [SD] age, 60.2 [10.8] years) was analyzed. During the first 6 months after DAA therapy, hepatitis C or liver disease-related costs decreased by $2498 (95% CI, -$3356 to -$1640) in patients with cirrhosis and by $486 (95% CI, -$603 to -$369) in patients without cirrhosis compared with control or untreated patients. Cumulative reductions in hepatitis C or liver disease-related costs during 30 months after DAA treatment were $15 808 (95% CI, -$22 530 to -$9085) in patients with cirrhosis and $5372 (95% CI, -$6384 to -$4360) in patients without cirrhosis. Among those who used DAA therapy compared with control patients, total medical costs decreased by $2905 (95% CI, -$4832 to -$979) in patients with cirrhosis and by $1287 (95% CI, -$2393 to -$283) in patients without cirrhosis during the first 6 months after DAA therapy. No statistically significant association was found between DAA therapy and total medical cost reductions after 12 months of follow-up. Cumulative reductions in total costs during 30 months after DAA therapy were $7074 (95% CI, -$18 448 to $4298) in patients with cirrhosis and $7497 (95% CI, -$14 287 to -$709) in patients without cirrhosis.
This study reported that DAA therapy appeared to be associated with a decrease in hepatitis C or liver disease-related costs for 30 months after treatment and with reduction in total medical costs for only 12 months after treatment in patients with or without cirrhosis. Longer-term follow-up studies with diverse outcomes are necessary to assess the value of DAA therapy.
直接作用抗病毒（DAA）疗法治疗丙型肝炎非常有效，但费用昂贵。关于 DAA 疗法是否降低下游医疗费用的证据很少。
研究 DAA 疗法与医疗保险受益人的治疗后医疗费用之间的关联。
设计、地点和参与者：这项回顾性队列研究从 2013 年至 2017 年的各种医疗保险索赔文件中获取数据。研究人群包括 2014 年诊断患有丙型肝炎的患者，他们参加了按服务收费的医疗保险和 Part D。使用多变量回归模型比较使用 DAA 治疗（治疗组）和未使用 DAA 治疗的倾向评分匹配队列（对照组）的患者在 30 个月的治疗后随访期间的医疗费用变化。该模型分别针对有和没有肝硬化的患者进行了估计。数据在 2019 年 9 月 1 日至 2020 年 3 月 31 日之间进行了分析。
完成 DAA 治疗。
建立了两个结果：丙型肝炎或肝病相关费用和总医疗费用。费用通过医疗保险允许的付款来衡量，包括医疗保险报销、患者责任和第三方付款。
对 15198 名患者（9038 名男性[59.5%]；平均[SD]年龄，60.2[10.8]岁）进行了倾向评分匹配队列分析。在 DAA 治疗后的头 6 个月内，肝硬化患者的丙型肝炎或肝病相关费用减少了 2498 美元（95%CI，-3356 至-1640），非肝硬化患者减少了 486 美元（95%CI，-603 至-369），与对照组或未治疗患者相比。在 DAA 治疗后 30 个月内，肝硬化患者的丙型肝炎或肝病相关费用累计减少 15808 美元（95%CI，-22530 至-9085），非肝硬化患者减少 5372 美元（95%CI，-6384 至-4360）。与对照组患者相比，在使用 DAA 治疗的患者中，在 DAA 治疗后的头 6 个月内，肝硬化患者的总医疗费用减少了 2905 美元（95%CI，-4832 至-979），非肝硬化患者减少了 1287 美元（95%CI，-2393 至-283）。在 12 个月的随访后，未发现 DAA 治疗与总医疗费用降低之间存在统计学关联。在 DAA 治疗后 30 个月内，肝硬化患者的总费用累计减少 7074 美元（95%CI，-18448 至 4298），非肝硬化患者减少 7497 美元（95%CI，-14287 至-709）。
本研究报告称，DAA 疗法似乎与治疗后 30 个月内丙型肝炎或肝病相关费用的降低以及治疗后 12 个月内总医疗费用的降低相关，但在有或没有肝硬化的患者中仅为 12 个月。需要进行具有不同结果的长期随访研究，以评估 DAA 疗法的价值。
