acase@tulane.edu / Background It is estimated 3 to 5 million individuals in the U.S. are chronically infected with the Hepatitis C virus (HCV). (Durham DP, 2016) More than 12,000 deaths occur annually in the U.S. as a result of HCV-related liver disease. (Wieland A, 2015) The cost of treatment medication for an individual with HCV genotype-1 is approximately $100,000 for 12 weeks of therapy. (Reau N, 2014) The exorbitant cost of HCV treatment has led to fears that many who could benefit from treatment will not receive it considering many with HCV are uninsured or have Medicaid. Purpose The purpose of this study is to quantify the cost, cost-effectiveness, and adverse outcomes associated with denying or delaying HCV treatment among the Louisiana Medicaid (LA-Medicaid) HCV GT-1 population. Methodology This project evaluates the cost and cost-effectiveness of treating HCV compared to not treating; initiating early treatment compared to late treatment and HCV-related health outcomes. A decision tree and Markov model simulates progression through the various states of health involved in progressive HCV disease, including death (hepatic and other causes). Results Don’t Treat/Treat Comparison Treatment was generally cost-effective, exhibiting an incremental cost-effectiveness ratio (ICER) of $21,670/life-year and $37,067/QALY (Quality-Adjusted Life-Years) gained. Optimal Treatment Stage Comparison Treatment of a person at F0 was cost effective, exhibiting an ICER of $6,482/QALY and $6,194/year of life compared to not treating at all and treating at F1, F2, F3, F4 or after LT. Conclusion Treatment of HCV-infected patients without liver fibrosis or in early stages of liver fibrosis appear to be more cost-effective than treating in advance stages of liver fibrosis or denying treatment. / 1 / Dwana Green

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