CBO Report Assesses Budgetary Effects of Potential Policies to Increase Hepatitis C Treatment

A new report from the Congressional Budget Office (CBO) analyzed 2 sample national policies to increase hepatitis C treatment rates among Medicaid enrollees and found that health care savings fueled by increased hepatitis C treatment would more than offset direct spending on treatment.¹ However, outreach would be key to increase testing and treatment and the associated costs would need to be accounted for, and future work to explore longer-term budgetary effects is needed.

The report references an initial CBO analysis of the potential effects of policies that would increase rates of hepatitis C treatment among the Medicaid population. Medicaid enrollees were the focus because populations at an increased risk of hepatitis C infection—such as those using injection drugs and individuals who have been involved with the criminal justice system—are likely to be covered by Medicaid. The CBO conducts nonpartisan analyses of budgetary and economic issues to support the Congressional budget process but does not make policy recommendations.²

Hepatitis C, the most common blood-borne infection in the US, exhibits few symptoms but is the most common cause of liver cancer.³ Hepatocellular carcinoma related to hepatitis C virus is the fifth most common cancer worldwide, and approximately 85% to 90% of these cancers are linked with hepatitis C virus.⁴ Although there is no vaccine for hepatitis C, direct-acting antiviral (DAA) therapies are associated with an excellent cure rate, and treating hepatitis C successfully significantly reduces the risk of developing subsequent hepatocellular carcinoma.

Hepatitis C, the most common blood-borne infection in the US, exhibits few symptoms but is the most common cause of liver cancer. | Image credit: LIGHTFIELD STUDIOS - stock.adobe.com

“Despite the availability of improved medication, diagnosis and treatment of hepatitis C have been hindered by low levels of awareness about the virus, the challenges of reaching high-risk populations (such as people using injection drugs) for screening and treatment and of ensuring adherence through the full treatment regimen, and the high cost of DAAs,” the authors of the CBO report noted.¹

In the new report, the CBO assessed a pair of illustrative 5-year plans that would see treatment rates increase by 10% and 100% above the rates currently seen among Medicaid beneficiaries. Both programs would see increasing rates as outreach is conducted over the course of 2 years, at which time they would reach a peak in treatment rates, and then have 3 years of maintaining peak levels. After this 5-year period,, rates of treatment would return to those currently projected.

“Those rates do not reflect CBO’s view of potential outcomes for any particular policy,” the report authors wrote. “Specific policies could result in higher or lower levels of treatment depending on the program put in place, the amount of investment in hepatitis C medications, and the extent of outreach to identify people who have the disease and connect them with treatment.”

Avoided Hepatitis C–­Related Costs Would Offset Spending on Treatment

One finding highlighted in the report was the potential for health care cost savings, as the cost of increased hepatitis C treatment would be more than offset by reduced spending on treatment related to hepatitis C complications.

The CBO estimated that that approximately $0.7 billion in spending on the treatment of hepatitis C complications would be averted over a 10-year period with a 10% increase in the rate of hepatitis C testing and treatment. In the same period, the amount spent on hepatitis C testing and treatment would rise by an estimated $0.5 billion. If the treatment rate peaked at a 100% increase, about $7 billion in spending would be avoided, while the amount spent on testing and treatment would be approximately $4 billion.

Most savings would occur in the second half of the 10-year period in both the 10% and 100% peak increase scenarios, and both scenarios assume that enrollees would remain covered by Medicaid throughout the period when complications may have occurred sans treatment.

The Need for Outreach to Increase Hepatitis C Testing and Treatment

Hepatitis C is typically asymptomatic in its early stages, making increased awareness and outreach crucial aspects of improving testing and treatment rates. The analysis did not encompass the costs of outreach and implementation, the authors noted, adding that a comprehensive accounting of the costs of the potential policies would include estimated costs of outreach and implementation to identify those with hepatitis C and ensure they initiate and adhere to treatment.

“Whether the total federal costs of outreach, testing, and treatment would be fully offset by savings from averted health care spending would depend on the specific program put in place and the number and characteristics (such as insurance coverage) of people who are newly treated,” the authors wrote.

Long-Term Budgetary Effects Are Particularly Relevant

The report emphasized the importance of future assessments of short- and longer-term effects of policies surrounding hepatitis C treatment, including beyond the 10-year period typically explored by the CBO. This is because hepatitis C progresses slowly, making long-term budgetary effect analyses relevant.

“Over a longer period, policies to increase hepatitis C treatment could result in greater savings from averted health care costs and reduced incidence of the virus, as well as greater costs from increased longevity,” the authors wrote. “In future work, CBO will assess the effects of treating hepatitis C beyond the budget period on a range of federal programs and spending.”

References

1. Budgetary effects of policies that would increase hepatitis C treatment. Congressional Budget Office. June 14, 2024. Accessed June 20, 2024. https://www.cbo.gov/publication/60237

2. Introduction to CBO. Congressional Budget Office. Accessed June 20, 2024. https://www.cbo.gov/about/overview

3. Underferth D. Hepatitis C and liver cancer: what to know. MD Anderson Cancer Center. Accessed June 20, 2024. https://www.mdanderson.org/publications/focused-on-health/HepatitisC-liver-cancer-What-you-need-to-know.h16Z1591413.html

4. Luna-Cuadros MA, Chen HW, Hanif H, Ali MJ, Khan MM, Lau DT. Risk of hepatocellular carcinoma after hepatitis C virus cure. World J Gastroenterol. 2022;28(1):96-107. doi:10.3748/wjg.v28.i1.96