Rationale for extending Medicaid eligibility to uninsured persons with chronic hepatitis B infection

Chronic hepatitis B (CHB) infection is a serious health problem for 1.2 million Americans leading to end-stage liver disease, primary liver cancer and premature death. The prevalence of chronic hepatitis B in the general population is less than 1% whereas 10-15% of Asians-Americans have CHB infection. Although improved treatment can help prevent the long-term sequelae, costs for persons without healthcare coverage are prohibitive. Unfortunately, many CHB-infected persons are uninsured, including a disproportionate number of Asian-Americans. They present to the health care system late, requiring expensive treatment for late-stage complications costing Emergency Medicaid excessive amounts of money for conditions that could be prevented with more timely intervention. A Markov analysis was conducted to determine the cost-effectiveness of extending Medicaid eligibility to uninsured CHB-infected persons in NYC. Chronic hepatitis B disease states were defined and two Markov state transition models were designed to emulate disease progression with and without the intervention provided by the demonstration project. Standard of care and associated costs were defined for each disease state to tabulate project costs and costs to Emergency Medicaid without the project. The analysis suggests substantial health improvements and cost savings will accrue to Medicaid from expanding access to care for CHB-infected individuals in NYC. With appropriate monitoring and management of the infection, the demonstration project can prevent disease progression in infected individuals. Subsequently, this will reduce the need for more expensive interventions funded by Emergency Medicaid, including liver transplants; improve the quality of life for chronically infected people; and consequently, save lives.