Clinical and economic outcomes of direct-acting antivirals for chronic hepatitis C infection in Oklahoma Medicaid.

摘要

Background: Newer direct-acting antiviral (DAA) Hepatitis C virus (HCV) regimens have not been studied extensively in the Medicaid setting. The goal of this study was to determine post-treatment initiation clinical and economic outcomes for chronic HCV-infected Oklahoma Medicaid members, assess factors associated with those outcomes, and evaluate predictors of 3-day treatment gap between prescriptions or treatment failure (i.e., non-completion).;Methods: This cross-sectional study analyzed Oklahoma Medicaid pharmacy and medical claims data for adult members using a newer DAA agent during January 1, 2014 to June 30, 2015. During this period, a Prior Authorization (PA) program instituting stricter criteria for coverage was implemented. All analyses were stratified by presence in this program. Multivariable analyses assessed the economic outcome of combined pharmacy and medical costs, the clinical outcomes of healthcare utilization (i.e., hospitalization/ER visit), and gap/failure based on member demographics, clinical characteristics, comorbid conditions, PA program, and presence advanced liver disease.;Results: Overall, 354 members were included in the study. There were 184 pre-PA individuals and 170 PA individuals. Total post-treatment initiation expenditures summed to around ;Conclusion: Newer DAA regimens presented a substantial economic burden in the Oklahoma Medicaid setting. Healthcare utilization was associated with treatment failure, although this appeared to be moderated by presence in the PA program. Future studies should integrate comprehensive clinical data and evaluate interventions on treatment gap/failure.