Washington’s hepatitis C elimination initiative improves treatment access, reduces costs

It took less than 22 years after the discovery of the hepatitis C virus (HCV) for a fast-acting, highly effective treatment to become available. Modern drugs are more than 95% effective at curing hepatitis C infection, yet the virus remains a critical public health problem. It's the most common bloodborne illness in the United States, and disproportionately impacts low-income people and marginalized communities. 

A directive signed by former Gov. Jay Inslee in 2018 aimed to eliminate the disease from Washington state by 2030. The first-in-the-nation plan called for coordination between public health agencies, increased screening, removal of barriers to care and a new approach to purchasing antiviral medications at a discount. 

A new study led by the University of Washington found that the plan not only expanded access to tests and treatment, but may save money in the long run. Published Feb. 10 in JAMA Network Open, the study found that total costs for hepatitis C-related care rose when the program was first implemented but have declined since, even as increased screening identifies more cases. 

"Comprehensive health insurance claims data can help us see how patterns in testing, treatment and healthcare costs are changing over time across a large population," said lead author Ashley Tabah, who worked on the study while completing a doctoral degree at the UW. "That kind of information can help states better understand how initiatives to expand access to care may affect both patients and the healthcare system."

Working in collaboration with the Washington State Health Care Authority and the Washington State Department of Health, researchers analyzed medical claims data between January 2017 and September 2022. Records included medical and pharmacy claims collected from both private insurance companies and public payers. The data represented about 70% of Washington residents, approximately 6-8 million individuals per year. 

Researchers found that the number of HCV tests administered increased sharply after Washington implemented the elimination initiative. There was a median of 28,375 tests per month at the end of 2017, peaking at 99,161 by July 2020. The number of tests then leveled off at a median of 55,844 per month throughout 2021. Researchers noted that these shifts also aligned with new national guidelines that recommended all adults receive at least one HCV test. Consistent with increased screening, the study observed an initial increase in the total number of HCV cases, followed by a significant decline over time as more people received treatment.

The study also found that total HCV-related costs spiked immediately after implementation of the initiative, but then dropped closer to initial levels. Total monthly costs rose from $45.6 million in 2017 to $70.8 million in 2019, an increase the researchers attributed to expanded screening, which identified more cases to treat. Monthly costs then declined to $56.8 million in 2021. 

While total HCV care costs rose, costs per patient declined by more than 45%. Researchers said the decline may be due to increased screening catching more infections in otherwise healthy people, which would likely improve treatment outcomes and reduce associated risks over time. 

"As an observational study, we cannot directly attribute the changes over time to the state initiative," said co-author Pamela Kohler, a professor of global health and of child, family and population health nursing at the UW. "However, it does support the idea that investing in screening and treatment of healthy people without symptoms is more cost-effective than waiting until they become sick."