The association of direct-acting antiviral therapy with health care utilization and costs in patients with chronic hepatitis C virus infection: A systematic review of real-world studies in the United States.

Abstract

Hepatitis C is a viral infection that can lead to severe liver damage, liver cancer, and death. However, it has remained a major public health concern, affecting millions worldwide, including over 2.4 million people in the United States. Although the advent of direct-acting antiviral (DAA) therapy has significantly improved treatment outcomes, the high cost of these drugs poses challenges for health care systems. Most economic evaluations of DAA therapy rely on simulation models, which often overlook individual, geographic, and health system variations, limiting their relevance for policy decisions. To synthesize evidence from retrospective observational studies on health care utilization and cost of care among patients with hepatitis C treated with DAA therapy, compared with those receiving pre-DAA treatments, a combination of pre-DAA, and no treatment. The goal is to understand real-world health care costs and utilization patterns, which simulation-based approaches cannot capture. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, US-based retrospective observational studies published between 2010 and 2024 were considered. A comprehensive search was conducted across multiple databases: MEDLINE, Embase, Web of Science Core Collection, ProQuest, EconLit, and Health Technology Assessment. Data, methods, and results information were extracted and synthesized. A total of 1,981 records were identified across databases. Most were excluded due to irrelevant comparisons, non-US populations, or outcomes unrelated to utilization and cost (eg, mortality or hospitalization rates). Ultimately, 6 studies met the inclusion criteria. The most common reasons for exclusion were methodological limitations, such as reliance on cost-effectiveness simulation models or a primary focus on access barriers. This systematic review reveals significant gaps in the real-world economic evaluation of DAA therapy. In particular, longitudinal data, geographic granularity, and state-specific analyses are lacking. Future research should address these limitations and further explore the long-term impacts of DAA therapy and variations in access and costs across different populations and insurance programs.