The Price of NOT Curing Hepatitis C

The Price of NOT Curing Hepatitis C

07.14.14 | By Robert Zirkelbach

“Over the next 20 years, total annual medical costs for patients with HCV infection are expected to more than double, from $30 billion to over $85 billion.”

Over the past few months, there has been increased focus on the price of a new cure for hepatitis C, with some stakeholders arguing that the country cannot afford to pay for this new treatment. But what is often left out of these discussions is the price all of us will pay if we are unable to develop new treatments and new cures for some of the most debilitating and costly diseases affecting Americans, such as cancer, diabetes, heart disease, and Alzheimer's. 

A previous report from Milliman, written before the most recent treatments became available, highlights the unsustainable cost burden on society of treating patients with hepatitis C. This analysis projected that without new treatments and cures for hepatitis C annual medical costs for patients with this disease would more than double from $30 billion to over $85 billion over the next 20 years - an unsustainable trend. 

The good news is that new and forthcoming treatments for hepatitis C have shown to cure the disease in over 90 percent of patients - transforming patients' lives and helping to avert billions of dollars in hospitalizations and costly medical services, such as liver transplants. More important than avoiding the financial burden of hepatitis C, a cure offers patients the hope of leading a life without the fear that very serious and often deadly complications will develop. As the Milliman report points out, complications associated with the disease are particularly gruesome: “Chronic HCV infection can progress to cirrhosis, liver cancer (hepatocellular carcinoma), and liver failure – collectively referred to as advanced liver disease. Treatments for advanced liver disease include procedures to drain ascites (the fluid that accumulates in the abdomen), medications, endoscopic intervention, or surgery to manage esophageal varices (dilated veins that can rupture and produce life-threatening hemorrhage), and liver transplantation.”

The benefits of curing hepatitis C are why some insurers have said the cost of these new treatments are worth the cost.

From the Milliman report:

  • The report notes that while at least 3 million Americans are infected with hepatitis C, “more than three out of every four (78%) are unaware of their infection.” This suggests that cost estimates of new medicines to treat hepatitis C that are based on 3 million Americans receiving the treatment are grossly overstated.  
  • The projected costs of not curing hepatitis C patients are staggering. According to Milliman, “Over the next 20 years, total annual medical costs for patients with HCV infection are expected to more than double, from $30 billion to over $85 billion, and remain elevated. Medicare shows the most dramatic cost change, increasing fivefold from $5 billion to $30 billion.” Moreover, the Milliman report notes that “HCV-related liver disease is a leading reason for liver transplants” and forecasts that without better treatment, “the total number of patients with advanced liver disease in 20 years will be more than four times greater than it is today.” 
  • Moreover, the report states that “the per-patient cost of caring for people with chronic HCV infection will increase 3.5 times in 20 years.”
  • Milliman also notes that the number of new patients with HCV is actually declining. “New HCV infections have declined dramatically over the last two decades,” they wrote. “With fewer than 20,000 new transmissions per year, new cases make up a very small portion of the total prevalence.” A decline in the number of new infections combined with new cures to treat the disease provide an unprecedented opportunity to make progress in the fight against hepatitis C, giving hope to patients and helping to achieve long-term cost savings.

The Milliman report sums it up this way: “Our projections suggest that without improvements to the current low effective treatment rate, the U.S. healthcare system will be burdened with more HCV-infected patients progressing to cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma, and ultimately, more patients requiring liver transplants. As more HCV infected people progress to advanced liver disease, we project these serious conditions to generate a rapidly growing portion of medical costs for HCV-infected people over the next 5 to 10 years, and lead to a dramatic increase in costs over the next 20 years. In the absence of improved and accessible treatments that can alter the progression of disease, payers, especially Medicare, will feel the impact of a baby boomers’ advanced liver disease epidemic.”

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