The Economic and Clinical Impact of Hepatitis C Treatment on Pennsylvania Medicaid

Principal Investigator(s)

Walid Gellad, MD, and Mark S. Roberts, MD

More than 3 million people are chronically infected with hepatitis C virus (HCV) in the US, and the majority of these individuals are unaware of their disease. HCV infection is the leading cause of hepatocellular carcinoma, and is the most common indication for liver transplantation today. The economic burden associated with chronic HCV infection in the United States is large, due to the treatment of advanced complications and liver transplantation. Until recently, the treatment of HCV has been disappointing, with sustained virologic response in well under 50% of those treated, with duration of treatment between 24-48 weeks and with several side effects. 

The recent approval of new all-oral treatment for HCV, including harvoni and viekira pak by the Food and Drug Administration, marks the beginning of a new era for HCV treatment. Previously, the old standard-of-care was based on peginterferon and ribavirin, with or without boceprevir and telaprevir. With the advent of these new medications, HCV treatment can for the first time be provided without interferon-based therapy, which is associated with considerable toxicity. As a result, many patients who were unable to tolerate previous therapies are now eligible for HCV treatment. These agents are superior, with sustained virologic response (SVR) rates as high as 97% in some patients, with shorter duration of treatment and fewer adverse effects than the old treatment.

This project estimates the number of people infected with HCV, genotype prevalence, the stage of disease at time of diagnosis, and the presence of other comorbidities.

Although the new drugs for the treatment of Hepatitis C are very effective, they are also very expensive. Sofosbuvir is currently priced at $1000 per day and simeprevir at $790 a day. The total cost of treatment can be as high as $170,000 per patient. Although expensive, the very high SVR rates have substantial potential to clear the virus and prevent many of the complications of the disease, such as decompensated cirrhosis and the need for liver transplantation.