Benefits of Expanding HCV Treatment Outweigh Short-Term Costs for State Medicaid Programs

Antibiotic costs
Antibiotic costs
Findings suggest that states should consider revising their HCV treatment policies to include all individuals infected with HCV to achieve significant patient- and population-level benefits.

Although increasing access to hepatitis C virus (HCV) treatment in the Medicaid population will raise short-term costs, it will also save money and improve health within a 10-year window, according to a study published in BMC Health Services Research.1

Even though direct-acting antiviral (DAA) therapies have been demonstrated to cure HCV infection in 90% to 100% of treated patients,2 many state Medicaid programs have restricted access to effective, but more costly, DAA therapies because of rising costs of care for HCV.3 For example, state Medicaid programs in North Carolina (NC) and Wisconsin (WI) have sobriety requirements for treatment, whereas states such as Oregon (OR) have recently lifted all restrictions.1 Therefore, researchers sought to demonstrate that states can expand DAA treatment access to a broader Medicaid population while balancing short-term budget concerns.

Researchers used the HCV Transmission and Progression Markov model to quantify the effect of removing restrictions to HCV treatment access on infected populations, expenditures, and net social value for the NC, OR, and WI Medicaid programs. They found that among all 3 states, removing access restrictions resulted in the greatest benefits over 10 years (net social value relative to baseline was $408 million each in NC and OR, and $271 million in WI) and the smallest infected population (5200 in NC, 2000 in OR, and 614 in WI). In addition, reduced disease transmission resulted in lower healthcare expenditures (−$66 million in NC, −$50 million in OR, and −$54 million in WI).

All the expanded treatment access policies achieved break-even costs (where total treatment and healthcare expenditures fell below those of baseline) in 4 to 8 years, and removing access restrictions yielded the greatest improvement in social value.

The study authors concluded that, “Patients and taxpayers would benefit by considering these gains and taking a more expansive and long-term view of HCV treatment policies.”1

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Disclosure: Funding for this research was provided by Gilead Sciences to Precision Health Economics in support of research design, analysis, and technical writing. The funder provided input on model design, manuscript edits, and publication outlet. All authors are employees of Precision Health Economics.


  1. Chou JW, Silverstein AR, Goldman DP. Short-term budget affordability of hepatitis C treatments for state Medicaid programs. BMC Health Serv Res. 2019;19(1):140.
  2. Hepatitis C treatments give patients more options. US Food and Drug Administration. Updated December 5, 2017. Accessed March 15, 2019.
  3. Assuring Medicaid beneficiaries access to hepatitis C (HCV) drugs. Center for Medicaid and CHIP Services. November 5, 2015. Accessed March 15, 2019.