The authors used a Markov model to compare two strategies for 45-55 year old Medicaid beneficiaries: (1) Current Practice—only advanced disease is treated before Medicare eligibility; and (2) Full Access—both early-stage and advanced disease are treated before Medicare eligibility. Full Access was less costly and more effective than Current Practice for all cohorts and perspectives, with differences in cost ranging from $5,369 to $11,960 and in effectiveness from 0.82 to 3.01 quality-adjusted life-years. Compared with Current Practice, Full Access averted 5,994 hepatocellular carcinoma cases and 121 liver transplants per 100,000 patients. “Two recently approved interferon-free drug regimens for patients with hepatitis C genotype 1 disease—sofosbuvir/ledipasvir (or ombitasvir, paritaprevir) and ritonavir with dasabuvir—are more than 94% effective in as few as 8 weeks for many patient subgroups, but most state Medicaid programs restrict their use due to cost,” said corresponding author Alexis P. Chidi, PhD, MSPH, of the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. “And while such restrictive treatment policies are likely to reduce short-term costs to state Medicaid programs,” she added, “our cost-effectiveness analysis revealed that for current Medicaid beneficiaries, the increased short-term costs of unrestricted access to care can be offset by savings from reduced complications in 9-16 years, depending on the treatment strategy and age of the cohort.”
The authors noted several study limitations. First, analytic methods that directly account for resource constraints may provide more precise estimates. Second, the study estimated treatment efficacy using clinical trial data, which may overestimate real-word effectiveness. Third, some Medicaid managed care plans may receive smaller drug discounts than those mandated by the Medicaid drug rebate program. Finally, the model used in the study only included liver-related costs and did not account for the potential increases in cumulative health care costs associated with reduced early mortality.
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