Long-term impact of broad treatment with hepatitis C cures
“Groundbreaking treatments for the hepatitis C virus (HCV) have cure rates of over 90%, but insurers were restricting access due to the high price of these therapies.”
A manufacturer was interested in presenting rigorous evidence to insurers and policymakers to quantify the long-term value of HCV therapies, which have cure rates of over 90% but have generated controversy over their pricing. Insurers were restricting access to these treatments due to affordability concerns. The long-term importance of enabling patients in early disease stages to access these treatments had not been evaluated at the societal level.
PHE developed a Markov model to simulate the benefits to HCV patients of treatment with new cures over a period of 50 years, including the impact of reduced transmission of HCV infection. This model considered the impact of broad versus narrow treatment access strategies for treating the population with HCV.
Within the United States, the study found that treating the entire population with HCV upfront would generate enormous value on the scale of $610 billion to $1.22 trillion over 50 years relative to a baseline scenario where the most recent treatments were not used. Treating patients upfront had greater value than waiting to treat patients only after they had progressed to more advanced stages of liver disease due to the infectious nature of HCV and the importance of reducing active disease transmission. Though treating all patients upfront would generate more value than costs in the long-term, the results suggest this outcome may currently be unattainable given budgetary limitations of payers and capacity limitations of specialty clinicians.
The results of this research were discussed at a Brookings Institute forum. Additionally, through publication in Health Affairs, the results of the research highlighted to insurers and policymakers the importance of taking a long-term perspective in economic and cost-benefit analysis of the value of HCV treatments, which have high upfront costs, but long-term value in preventing the development of advanced liver disease and cancer. More generally, the research suggests important policy considerations in determining the value of important but costly therapies like cures and the need for innovative reimbursement, financing, and delivery mechanisms in order to overcome short-term budgetary and capacity limitations.
The results of the research highlighted to insurers and policymakers the importance of taking a long-term perspective in assessing the value of HCV treatments.