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APHA Scientific Session and Event Listing

David Gilden, BS, Joanna Kubisiak, MS, and Daniel Gilden, MS. JEN Associates, 240 W. 95th St., #24, New York, NY 10025, 718-788-3060, dgilden@pipeline.com

Background: The US government's Medicare program covers physician and hospital costs for retirees and the long-term disabled. There are approximately 3 million Americans infected by hepatitis C, mostly through contaminated drug transfusions in the 1980s and early 1990s and through sharing syringes during recreational drug use. A growing population is at risk for progressive liver disease as the length of infection increases. At the same time, new therapies (ribavirin combined with interferon alfa in 1998 and with pegylated interferon alfa in 2001) are improving treatment outcomes.

Methods: We examined the medical billing records of a 5% national Medicare sample spanning the years 1997-2003. We confirmed patients' hepatitis C virus (HCV) infection by flagging beneficiaries with at least one HCV-related treatment procedure in a given year. Each year's cohort was categorized by age, race, gender and Medicare status and further stratified by level of care (e.g. repeated visits to liver specialists) and liver conditions. Medicare does not cover self-administered drugs, but we were able to obtain pharmacy claims for Medicare beneficiaries who were also covered by Medicaid.

Results: HCV patients in Medicare grew from 32,480 in 1997 to 104,020 in 2003. 12% had been diagnosed as opioid users. HIV coinfected averaged 4% over this period. A declining proportion of the total HCV population was elderly (44% in 1997 to 35% in 2003). Prevalent HCV cases – Medicare beneficiary identified with HCV in previous years – grew from 34% of the 1998 caseload to 62% in 2003. Liver-related costs for this evolving population increased proportionately with its total size, to almost $200 million in 2003. The fraction of patients under evaluation by liver specialists increased in 1999 (12.8%) and 2002 (13.5%), but declined in other years. In 2000, the midpoint for this period, 5.8% of Medicare-Medicaid hepatitis C patients received drug therapy. The death rate declined substantially in 1998 and 2002, making for a 17% decline over the 7-year period. At the same time, the incidence of advanced liver disease remained around 14.5%. Among comorbidities, diabetes was especially elevated in the HCV-treated elderly: the mean prevalence was 33% compared with 21% for elderly Medicare beneficiaries as a whole.

Conclusions: The Medicare population with regular HCV management grew dramatically between 1997 and 2003. In contrast to HIV, the new treatments for hepatitis C reached relatively few people, and their impact on Medicare costs, mortality and morbidity was comparatively small.

Learning Objectives: