Ramping up HCV elimination tactics could save 90,000 lives, $60 billion by 2050

WASHINGTON — An accelerated, nationally organized plan to eliminate hepatitis C virus in the United States could save more than 90,000 lives and nearly $60 billion by 2050, according to a health economics expert at The Liver Meeting.

“By 2030, approximately 10,000 deaths can be avoided. ... We expect to find by 2050 this program can result in 90,000 lives saved,” Jagpreet Chhatwal, PhD, director of the Institute for Technology Assessment at Massachusetts General Hospital and associate professor at Harvard Medical School, said during his presentation.

Chhatwal presented the Hep-Sim model, which incorporates changing demographics and rising incidence in different age groups; progression of disease from early to advance stages; therapeutic advances since 2001, including direct-acting antivirals; screening policies, which shifted from high-risk groups to universal screening; and diagnostic advances. The financial model then incorporates the cost of treatment associated with different insurance models.

Chhatwal demonstrated the impact of scaling up screening and treatment over the next few decades: If the United States maintains a status quo on all factors, rates of mortality from HCV would continue to decline, but not as much as if efforts were accelerated. Similarly, cases of hepatocellular carcinoma and cirrhosis could also be avoided, he said.

“Very similar story for hepatocellular carcinoma cases: By 2030 we would expect to see 70,000 cases avoided. By 2050, more than 100,000 cases avoided,” Chhatwal said. “Very similar with decompensated cirrhosis: By 2030 close to 30,000 cases can be avoided. By 2050, it was 90,000 cases.”

He reminded the audience that achieving elimination would also require more identification and diagnosis of those individuals living with HCV: “It’s not news to people in this room and, in fact, we have to look at about more than 3 million people. We are trying to find those in the system in the next 5 years and then treatment is also important. On average, if you can treat approximately 300,000 people per year and for the next 5 years that will help us get closer to eliminating hepatitis.”

Lastly, Chhatwal showed how HCV elimination in the U.S. would not only save lives but also money, demonstrating that the accelerated scenario saved $14.2 billion over the next decade, with $11.2 billion (79%) attributed to savings in Medicare or Medicaid.

“We cannot talk about hepatitis C or hep C elimination without talking about the cost,” Chhatwal said. “The accelerated program can result in approximately $14 billion savings in the next 10 years. ... This is unprecedented. We are not just eliminating a disease as a public health threat, but also saving money, which is not common. That gives us a lot of impetus to implement such a program.”

Chhatwal estimated a $59.3 billion cost savings by 2050, associated with treatment and diagnosis of HCV-associated disease. He also showed treatment costs would drop from $45.2 billion to $20.3 billion while disease management would drop from $87 billion to $54.1 billion.