Health care costs associated with disease progression of untreated chronic hepatitis C in the United States.

Abstract

Despite effective direct-acting antiviral therapies, two-thirds of US patients with chronic hepatitis C remain untreated, leading to significant public health and economic challenges. However, data on the economic burden of untreated chronic hepatitis C in the direct-acting antiviral era remain limited. To estimate health care costs related to disease progression among untreated, newly diagnosed adults with chronic hepatitis C in the United States. We conducted a retrospective observational study using US national commercial insurance data from January 2013 to December 2023. The cohort included adults aged 18 years or older with newly diagnosed, treatment-naive, and untreated chronic hepatitis C. Patients were categorized by liver disease stage-specific periods (chronic hepatitis C, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation), defined by the earliest recorded diagnosis of each stage and censored at progression. Liver disease-related costs, defined as costs with a primary diagnosis corresponding to these stages, were estimated using a 2-part model to account for excess zero costs. All-cause costs were estimated using generalized linear models with a γ distribution. Costs were calculated per person per month in 2023 US dollars. Among 36,923 untreated patients with chronic hepatitis C, adjusted all-cause health care costs per patient per month increased substantially with disease progression: $4,483 (95% CI = $4,326-$4,640) for chronic hepatitis C, $6,240 ($5,570-$6,910) for compensated cirrhosis, $14,166 ($12,259-$16,073) for decompensated cirrhosis, $19,021 ($15,283-$22,758) for hepatocellular carcinoma, and $27,836 ($9,325-$46,348) at the liver transplant stage (<i>P</i> < 0.001). Liver-related costs rose from 1.6% ($70) at the chronic hepatitis C stage to 30.4% ($5,791) at hepatocellular carcinoma, and 57.4% ($15,986) of all-cause costs at the liver transplant stage (<i>P</i> < 0.001). These findings highlight the critical importance of early treatment to reduce health care costs and improve clinical outcomes. Early screening and treatment can prevent progression to high-cost advanced liver disease.