Liver distress: Top 10 care and cost concerns

Patients infected with hepatitis C virus (HCV) are at high risk for the development of liver cirrhosis or liver cancer. Early detection and treatment, particularly with new direct-acting antiviral (DAA) therapies, are the keys to improved outcomes. But high costs and insurance issues continue to limit access to both diagnosis and treatment for many patients.

In our hepatology coverage this year, Medical Economics chronicled the main issues, new studies, and treatment advances that impact our readers’ business and clinical practice. Click through the slides (above/below) for a quick review of efforts to remove obstacles to optimal care for patients infected with HCV.

1. Treat early, trim costs

Treating patients early averts advanced liver disease and increases healthy life years. Early treatment also is more cost-effective: Decreasing drug costs would reduce the incremental cost-effectiveness ratio.

2. Could DAAs wipe out HCV?

Direct-acting antiviral (DAA) therapies could reduce HCV prevalence by more than 80%. But acceptance of DAAs must be tempered by high costs, limited insurance coverage, and willingness to treat PWIDs.

3. Closing the testing gap in infants

Perinatal HCV transmission can result in chronic infection that may cause severe liver damage. Screening of pregnant women is needed to identify HCV-infected children and direct them to proper care.

4. Primary care physicians measure up

PCPs treat patients with chronic HCV just as well as specialists, and adherence to visits is higher. Study authors called for universal policies that expand treatment access and more evidence-based guidelines.

5. Medicaid drug access limits lifted

New court rulings are changing states’ restrictions on Medicaid recipients’ access to HCV drugs: “Political opinion is changing the conversation away from costs and toward providing a long-term investment.”

6. HCV will drive mortality in Baby Boomers

HCV infection is common in this group and will drive higher mortality and resource utilization as Baby Boomers age. But the use of DAAs can reduce both and lead to long-term financial benefits.

7. Clearing high treatment hurdles

Direct-acting antivirals have revolutionized HCV treatment but cost and insurance coverage are key issues. A challenge to PCPs: expand Rx access by ID-ing patients and linking them to care.

8. Passing the cost test

A less costly alternative to nucleic acid testing as confirmation of a positive HCV antibody test looks promising to improve diagnostic capacity in settings of high HCV prevalence.

9. Patient cost sharing gets poor grades

High patient cost arrangements for novel DAA treatments that impose large out-of-pocket expenses are less than ideal, exposing patients to significant financial burdens when they’re least able to afford them.

10. DAA therapies paying off

New all-oral DAA regimens provide both short- and long-term clinical and economic value to society. They improve efficacy and tolerability and decrease total treatment costs and total lifetime costs.