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Long-term disease and economic outcomes of prior authorization criteria for Hepatitis C treatment in Pennsylvania Medicaid

机译：宾夕法尼亚医疗补助在宾夕法尼亚丙型肝炎治疗的经验授权标准的长期疾病和经济结果

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Background: Several highly effective but costly therapies for hepatitis C virus (HCV) are available. As a consequence of their high price, 36 state Medicaid programs limited treatment coverage to patients with more advanced HCV stages. States have only limited information available to predict the long-term impact of these decisions. Methods: We adapted a validated hepatitis C microsimulation model to the Pennsylvania Medicaid population to estimate the existing HCV prevalence in Pennsylvania Medicaid and estimate the impact of various HCV drug coverage policies on disease outcomes and costs. Outcome measures included rates of advanced-stage HCV outcomes and treatment and disease costs in both Medicaid and Medicare. Results: We estimated that 46,700 individuals in Pennsylvania Medicaid were infected with HCV in 2015, 33% of whom were still undiagnosed. By expanding treatment to include mild fibrosis stage (Metavir F2), Pennsylvania Medicaid will spend an additional $273 million on medications in the next decade with no substantial reduction in the incidence of liver cancer or liver-related death. Medicaid patients who are not eligible for treatment under restricted policies would get treatment once they transition to the Medicare program, which would incur 10% reduction in HCV-related costs due to early treatment in Medicaid. Further expanding treatment to patients with early fibrosis stages (F0 or F1) would cost Medicaid an additional $693 million during the next decade but would reduce the number of individuals in need of treatment in Medicare by 46% and decrease Medicare treatment costs by 23%. In some scenarios, outcomes could worsen with eligibility expansion if there is inadequate capacity to treat all patients. Conclusions and relevance: Expansion of HCV treatment coverage to less severe stages of liver disease may not substantially improve liver related outcomes for patients in Pennsylvania Medicaid in scenarios in which coverage through Medicare is widely available.
机译：背景：有几种高效但昂贵的丙型肝炎病毒（HCV）的昂贵疗法。由于其高价格，36个国家医疗补助计划对具有更先进的HCV阶段的患者有限的治疗覆盖率。各国只有有限的信息可用于预测这些决定的长期影响。方法：我们将经过验证的丙型肝炎MicroSumulation模型调整为宾夕法尼亚医疗补助人群，以估算宾夕法尼亚医疗补助的现有HCV患病率，并估算各种HCV药物覆盖政策对疾病结果和成本的影响。结果措施包括医疗补助和医疗保险的晚期HCV结果和治疗和疾病成本的率。结果：我们估计，宾夕法尼亚医疗补助46,700人在2015年感染了HCV，其中33％的人仍未令人未知。通过扩大治疗，包括轻度纤维化阶段（Metavir F2），宾夕法尼亚医疗补助将在未来十年中额外花费2.73亿美元的药物，没有大幅减少肝癌或与肝癌的发生率。在受限制政策下没有资格待遇的医疗补助患者将在向医疗保险计划过渡后得到治疗，这将导致与医疗补助的早期治疗有关的HCV相关成本减少10％。进一步扩展对早期纤维化阶段（F0或F1）的患者的治疗将在未来十年中额外收取2,0093,000美元的费用，但会减少需要在Medicare治疗的人数46％，并将Medicare治疗成本降低23％。在某些情况下，如果在治疗所有患者的能力不足，结果会因资格扩张而恶化。结论和相关性：扩增HCV治疗覆盖率对肝脏疾病的不太严重的阶段可能没有显着改善宾夕法尼亚医疗补助在通过Medicare覆盖的情况下的患者的肝相关结果。

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