ArticlePharmacoEconomics2025
Health Care Resource Utilization and Costs Associated with US Medicaid Sobriety Restrictions on Direct-Acting Antivirals for Hepatitis C Virus: A Retrospective Claims Database Analysis.
Article in PharmacoEconomics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsMany state Medicaid programs implemented sobriety restrictions that delay timely initiation of direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) infections. This claims database study examined the economic impact of sobriety restrictions on DAAs among Medicaid-insured patients with HCV.
methodsA retrospective database analysis of the Anlitiks All Payor Claims data (APCD) during the period January 1, 2020 to June 30, 2022 was conducted. Continuously enrolled adult (aged 18-64 years) Medicaid-insured patients with HCV who initiated DAAs (i.e., index date) during the period January 1, 2021 to December 31, 2021 with ≥ 12 months pre-index and ≥ 6 months post-index follow-up were categorized into two cohorts (states with sobriety restriction [SR] and states with no sobriety restriction [NSR]) based on the sobriety restriction status in the state of residence on the index date. Measures analyzed were the proportion of patients with one or more all-cause medical health care resource utilization (HCRU) (inpatient hospitalization [IP], emergency department [ED], outpatient [OP], professional office [PV], and other [OV] visits) and mean per-patient medical, pharmacy, and overall costs. HCRU and cost differences were compared using adjusted multivariable logistic and gamma-log link regression models, respectively.
resultsPatients in the SR (n = 2,295) versus NSR (n = 4,623) cohort had a higher mean age (45 ± 12.02 vs. 43 ± 11.51 years), fewer males (50.28% vs. 58.1%), and they had lower substance use rates (44.10% vs. 59.68%), all significant at p < 0.05. The SR vs. NSR cohort had higher rates of patients with all-cause HCRU by type (IP 22.0% vs.18.1%; ED 42.3% vs. 37.4; OP 62.5% vs. 55.4%; PV 76.4% vs. 69.1%; other visits 47.4% vs. 46.5%). The SR vs. NSR cohort had a significantly higher adjusted odds ratio (95% confidence interval) for IP (2.09; 1.59-2.73) and OP (1.52; 1.28-1.82). Similarly, the SR versus NSR cohort had a significantly higher all-cause adjusted least squares mean cost per patient for IP ($42,616 vs. $15,063), ED ($982 vs. $420), OP ($715 vs. $349), PV ($840 vs. $621), medical ($11,845 vs. $3,850), pharmacy ($53,453 vs. $38,298), and overall ($63,935 vs. $41,524).
conclusionPatients who initiated DAAs with SR versus NSR had 2 times and 1.5 times greater likelihood of IP and OP visits, respectively. Similarly, the SR versus NSR cohort had 3 times greater medical costs. Restricting DAA access among patients with HCV increases HCRU and cost burden, potentially impeding World Health Organization (WHO) 2030 HCV global elimination goals.
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