A Call for New Research in the Area of Hepatitis C

The Congressional Budget Office regularly provides information to the Congress about the effects on the federal budget of policies related to preventive medical care. Today the agency released a report providing background about hepatitis C treatment and the budgetary effects of illustrative increases in such treatment among Medicaid beneficiaries.

In addition to the report published today, further analysis is needed to determine the effects of proposed federal policies, such as a national treatment program, on both the extent of hepatitis C treatment and the federal budget. Policies could include efforts to expand outreach to identify people who have hepatitis C, such as improving the technology and scale of screening. Those policies could also improve access to care for newly diagnosed people, reduce the cost of the highly effective direct-acting antiviral (DAA) medications now used to treat hepatitis C, and support programs to make sure that people complete their treatment. As CBO builds its expertise about policies aimed at increasing hepatitis C treatment, it is finding significant gaps in the relevant research literature.

CBO’s estimation of the potential costs and savings associated with a national program to treat hepatitis C, including whether the program would result in net savings to the federal government, relies on three primary factors:

• The effectiveness of outreach and other efforts in increasing testing, treatment initiation, and adherence among targeted populations (which would also depend on the specific populations included in the program);
• The costs of treating hepatitis C with DAAs; and
• The costs of treating complications from hepatitis C if the disease is untreated.

Reliable research in those areas would provide CBO with the information it needs for its analysis.

A primary area of uncertainty involves the number of additional people who would be treated under a national hepatitis C treatment program. That number would depend on the details of the policy and on its effectiveness in reaching different populations. A national program could serve a range of populations, including Medicaid and Medicare beneficiaries, recipients of care provided by the Indian Health Service, people who are incarcerated, and people who are uninsured. Because risk factors for hepatitis C differ among those groups, the shares of people in earlier or more advanced stages of the disease could also differ in ways that could affect the cost of a treatment program (Ryerson and others 2020; Wenger and others 2014). In addition, savings to the federal government could differ depending on the degree to which the federal government subsidized people’s health care costs (for example, through a person’s current or future enrollment in a public program). New research on expected treatment rates, the effectiveness of efforts to reach high-risk populations, and factors affecting links between testing and treatment among different subpopulations would support CBO’s work on this topic.

Updated data on the costs associated with complications from hepatitis C would also be valuable to CBO’s analysis. CBO’s primary source of existing data is a 2011 study that quantified health care costs between 2001 and 2010 for privately insured patients with a hepatitis C diagnosis relative to a matched cohort without a hepatitis C diagnosis (McAdam-Marx and others 2011). Those data may not reflect current populations and health care practices. CBO would also value information on the effects of various procurement strategies on the prices of relevant drugs over time and the likelihood that drug manufacturers would participate in a process that allowed governments to procure unlimited hepatitis C medications at a fixed price.

Finally, research on the longer-term effects of expanded treatment of hepatitis C would be of interest, including effects on the incidence of the disease, on mortality related to hepatitis C, and on outcomes such as disability, labor force participation, and wages.

Please send comments to Chapin White, CBO’s Director of Health Analysis, at Chapin.White@cbo.gov.

Phillip L. Swagel is CBO’s Director.