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Budget impact analysis of a medicaid policy change for Hepatitis C treatment

Lopata, Erin (2017) Budget impact analysis of a medicaid policy change for Hepatitis C treatment. Master Essay, University of Pittsburgh.

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The availability of new and highly effective direct-acting antiviral treatments for the treatment of Hepatitis C virus infection created a new treatment paradigm for patients, and a significant budget constraint for health care payers. Many managed care organizations in the United States responded with the implementation of restrictive coverage policies, thereby limiting patient access to these new therapies. With many in the hepatitis C patient population unable to be treated, hepatitis C was poised to remain a significant public health issue. For this and other reasons, health care payers reevaluated their hepatitis C policies to allow coverage of a broader population. This positive change in hepatitis C access will likely result in a higher total pharmacy cost for the payer; however, this cost may potentially be offset in the future by reduced costs related to liver disease complications. To properly allocate the Medicaid budget for the 2018 calendar year, a budget impact model was developed. The objective of this model was to predict the number of hepatitis C patients treated in the year following a policy change, which allowed for the treatment of all patients. The modeling methodology utilized internal health plan pharmacy and medical claims data to describe the characteristics of the hepatitis C population over the past two years. Some input values were unable to be estimated using internal data; thus, relevant values from clinical literature were used. To account for uncertainty related to the variables, a sensitivity analysis was conducted to construct a realistic range of patients treated and associated pharmacy costs for 2018. The model predicted that 176 to 373 additional patients would be treated for hepatitis C, at an increased incremental pharmacy cost of $6,020,112 to $22,154,475 in 2018. Although the policy change will result in increased pharmacy costs for the Medicaid payer for 2018, it will improve patient access to treatment for this public health issue and may potentially decrease incidence and cost related to liver complications in the future.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Lopata, Erineml76@pitt.edueml76
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFinegold, Daviddnf@pitt.edudnfUNSPECIFIED
Committee MemberDonohue, Juliejdonohue@pitt.edujdonohueUNSPECIFIED
Date: 5 December 2017
Date Type: Completion
Number of Pages: 40
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 17 Jul 2018 15:58
Last Modified: 17 Jul 2018 15:58


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