July 2, 2013

Successful hepatitis C treatment lowers subsequent costs

OAKLAND, Calif. — Successful treatment of chronic hepatitis C virus (HCV) infection has some key economic benefits, including the reduced use of health care resources and associated medical costs within the first five years following treatment, as described in the current online issue of the Journal of Managed Care Pharmacy.

A new study by the Kaiser Permanente Division of Research determined that related reductions in health care costs and utilization actually begin in a relatively short time — within the first five years for those patients who achieve sustained virologic response as a result of treatment.

Achieving sustained virologic response (SVR), defined as undetectable HCV in the blood at least 6 months after the completion of anti-HCV therapy, is the primary goal of HCV treatment. Eradicating the virus (through SVR) can reduce the future risk of advanced liver disease, liver transplant and liver-related death.

“Studies suggest that chronic hepatitis C patients who achieve sustained virologic response have lower risks of liver-related morbidity and mortality,” said lead author M. Michele Manos, PhD, MPH, DVM, a senior investigator at the Division of Research and director of the Viral Hepatitis Registry. “Given the substantial costs and complexity of hepatitis C antiviral treatment, it’s important to understand and quantify the post-treatment benefits.”

Approximately 4 million people in the U.S. have chronic hepatitis C, a slowly progressing disease that is relatively asymptomatic until severe liver disease develops. At least 50 percent of the infected population in the US remains undiagnosed today. The costs of treating HCV-related complications are expected to rise substantially in the next 5 to 10 years, as the majority of patients will have been infected for more than two decades and are at increasing risk of developing advanced liver diseasel.

The five-year study followed 1,924 adult patients who had undergone antiviral therapy for chronic HCV infection between 2002 and 2007 within Kaiser Permanente Northern California, a comprehensive, integrated health care delivery system. Almost half — 48 percent — had achieved sustained virologic response.

Health care utilization and cost data were obtained for each patient from the Kaiser Permanente Northern California electronic medical record system and other automated databases. Cost and health care utilization categories included hospitalization and outpatient encounters, including emergency department and office visits, as well as laboratory services and pharmacy.

Compared with those whose treatment was successful (SVR), patients in the non-SVR group incurred significantly higher post-treatment costs in all categories assessed. Post-treatment total (all cause) costs per person per year were $6,301 for the SVR group and $10,149 for the non-SVR group. After adjusting for other factors that influence costs of care, the total costs for the non-SVR group were 26 to 64 percent higher than those for the SVR group during each of post-treatment years 1 to 5.

In post-treatment years 2 to 5, overall laboratory test rates were approximately 60 to 80 percent higher in the non-SVR group compared with those who attained SVR; and liver-specific laboratory test rates were 70 to 130 percent higher. Internal medicine (including gastroenterology and infectious diseases) clinic visit rates were 20 to 40 percent higher. Hospitalization rates fluctuated by post-treatment year from 10 to 145 percent higher in the non-SVR group compared with SVR patients.

“Our findings are not unexpected. The cost of caring for patients with hepatitis C increase as liver disease severity progresses,” said Manos. “Currently we have the rapid introduction of novel HCV antivirals with increasingly greater success rates and higher costs. It’s essential to have a firm grasp of post-treatment cost savings — which are independent of therapy type — when estimating the overall cost-effectiveness of each of the new antiviral strategies.”

Researchers added that due to the typically slow progression of liver disease, the cost-savings afforded by successful HCV treatment may increase with post-treatment time.

Kaiser Permanente can conduct transformational health research in part because it has the largest private patient-centered electronic health record system in the world. The Viral Hepatitis Registry maintains administrative and clinical data for all Kaiser Permanente Northern California patients with chronic hepatitis C and hepatitis B. The organization’s electronic health record system connects Kaiser Permanente’s research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.

Other authors on the study were Jeanne Darbinian, MPH, G. Thomas Ray, MBA, Valentina Shvachko, MS and Charles Quesenberry, PhD, of the Kaiser Permanente Division of Research; Jaime Rubin, MPH, Baris Denis, MSc, Fulton Velez, MD, MSPharm, MBA, of Vertex Pharmaceuticals Incorporated, Cambridge, MA. The study was funded by Vertex Pharmaceuticals Incorporated, with additional support from The Permanente Medical Group.

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, the Division’s550+ staff are working on more than 350 ongoing research studies in behavioral health and aging, cancer, cardiovascular and metabolic conditions, health care delivery and policy, infectious diseases, vaccine safety and effectiveness, and women's and children's health.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.