Working Paper: NBER ID: w31139
Authors: Jagpreet Chhatwal; Alec Aaron; Huaiyang Zhong; Neeraj Sood; Risha Irvin; Harvey J. Alter; Yueran Zhuo; Joshua M. Sharfstein; John W. Ward
Abstract: The national hepatitis C elimination initiative provides an opportunity to dramatically expand access to hepatitis C virus (HCV) treatment and put the US on a path to eliminating hepatitis C. Our objective was to project the health benefits and cost savings of this initiative. A previously developed mathematical model was updated to simulate trends in HCV disease burden and cost of care in the US for the next 20 years under status quo and national hepatitis C elimination initiative. Within five years, the initiative will diagnose 92.5% of all persons with HCV and cure 89.6% of HCV infection. Over 10 years, compared with the status quo, the initiative will avert 20,000 cases of hepatocellular carcinoma, 49,100 cases of diabetes, and 25,000 cases of chronic kidney disease. The initiative will also avert 24,000 deaths adding 220,000 life years. These benefits in improved health will save $18.1 billion in direct healthcare spending, of which $13.3 billion would accrue to the federal government. Over 20 years, the health benefits would increase by more than 2-fold and cost savings by 3-fold. The cost savings would further increase if the HCV incidence rate decreases because of rapid decline in HCV prevalence. In conclusion, the national hepatitis C elimination initiative would substantially reduce HCV-related morbidity and mortality and would reduce healthcare spending at 10 years and beyond.
Keywords: Hepatitis C; Elimination Initiative; Health Benefits; Cost Savings
JEL Codes: I1; I13; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| National hepatitis C elimination initiative (I18) | Diagnosis of 92.5% of all persons with HCV (I13) |
| National hepatitis C elimination initiative (I18) | Cure for 89.6% of those diagnosed (I12) |
| National hepatitis C elimination initiative (I18) | Avert 20,000 cases of hepatocellular carcinoma (I12) |
| National hepatitis C elimination initiative (I18) | Avert 49,100 cases of diabetes (I12) |
| National hepatitis C elimination initiative (I18) | Avert 25,000 cases of chronic kidney disease (I12) |
| National hepatitis C elimination initiative (I18) | Prevent 24,000 deaths (I12) |
| National hepatitis C elimination initiative (I18) | Addition of 220,000 life years (J17) |
| National hepatitis C elimination initiative (I18) | Savings of $181 billion in direct healthcare spending (H51) |
| Savings of $181 billion in direct healthcare spending (H51) | $133 billion of that savings accruing to the federal government (H59) |
| National hepatitis C elimination initiative (I18) | Health benefits expected to increase by more than twofold (I15) |
| National hepatitis C elimination initiative (I18) | Cost savings expected to increase by threefold (O22) |
| Decrease in incidence rate of HCV (I12) | Further cost savings (D61) |