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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



Healthcare Cost of Hepatitis C-infected Members in a Managed Care

This article appeared in the December Health Policy Our Sponsors from
Thomas Jefferson University's Medical College.   The MCO studied was a
73,869 member medicaid MCO.    The data presented includes:

From a cohort of 73,869 medicaid MCO members studied, 395 (0.535%)
met the inclusion criteria for Hepatitis C Virus.  The mean age was 46.5 years.   The 395 members had medical claims totaling $4,075.082.  Inpatient hospital services accounted for 48% of these costs.  Further analysis showed that patients
with a history of transplant or transplant procedure (=12) performed in 1999
had medical claims totaling $600,445.  Inpatient claims for this group
accounted for $497,594 of the total medical claims.  In addition, there was
a significant patient outlier that had total medical costs of $881.933.  The
majority of these costs were related to home care.   These 13 patients
(homecare) accounted for 36% of all medical costs for Hepatitis C Virus members.    The article goes into co-morbid costs associated with HIV, renal failure, pneumonia, etc..     Rx claims for the total membership in treatment were
$1,495,096.  Only 60 of the individuals identified from the 395 were on
combination therapy (Rebatron) while 25 were on monotherapy.   Rx claims for
treatment of Hepatitis C Virus accounted for only $437,735 of the total $1,495,096.   The vast majority of other Rx costs were associated with behavioral health (depression), cardiovascular and respiratory medications.

Total healthcare and Rx claims for this MCO totaled $5.5 million for
1999.  By my calculations, the total PMPY costs for the MCO were $74 or
$6.16 PMPM.   The total Per Patient Per Year costs (PPPY) were approx.
$14,000 or $1,260 PPPM.     The conclusion of the article authored by Amy
Phillips, Pharm. D. at Abbott Labs was that..."as the number of persons with
Hepatitis C Virus is expected to increase, the overall cost of healthcare for these
patients is likely to be significant"!