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Healthcare Cost of
Hepatitis C-infected
Members in a Managed Care
Organization.
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.
Thearticle 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"!
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