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734A AASLD ABSTRACTS HEPATOLOGY, October, 2015 Ronald D’Amico - Employment: AbbVie; Stock Shareholder: AbbVie Peter Ferenci - Advisory Committees or Review Panels: Idenix, Gilead, MSD, Janssen, Salix, AbbVie, BMS; Patent Held/Filed: Madaus Rottapharm; Speaking and Teaching: Gilead, Roche The following authors have nothing to disclose: Hans Van Vlierberghe, Greg Ball 1068 The healthcare cost burden of HCV-infected baby boomers in the US Ron Brookmeyer 2 , Timothy R. Juday 1 , Darius Lakdawalla 3,4 , Steven Marx 1 , Gigi Moreno 4 , Yuri Sanchez 1 ; 1 HEOR, AbbVie, Mettawa, ID; 2 David Geffen School of Medicine at UCLA, Los Angeles, CA; 3 USC, Los Angeles, CA; 4 Precision Health Economics, Los Angeles, CA Background While the incidence of hepatitis-C virus (HCV) infection peaked more than 25 years ago, the untreated infected population is aging and experiencing expensive liver complications, raising questions about future financial burdens for Medicare. To shed light on this, we quantified healthcare costs for 50-64 year-old “baby boomers” with HCV by diagnosis and insurance status. Methods This study conducted a literature review and analyzed five waves of National Health and Nutrition Expenditures Survey (NHANES) data from 2003- 2004 through 2011-2012. Insurance, HCV infection, and diagnosis status were obtained from NHANES. Respondents were identified as diagnosed if they tested positive for HCV, responded to the follow-up interview, and reported awareness of their HCV infection prior to NHANES. The analysis focused on respondents with HCV RNA, indicating chronic infection. The final sample contained 28,607 respondents. Healthcare costs for chronic HCV reported in the literature were applied to estimate total HCV costs. Results Among the 2.7 million Americans with chronic HCV, approximately 1 million are aged 50–64. Of these, about 319,003 are undiagnosed, and 161,609 are diagnosed but uninsured. Privately insured chronic HCV patients cost $17,176 annually if suffering from noncirrhotic disease (NCD), $22,752 if suffering from compensated cirrhosis (CC), and $59,995 if suffering from endstage liver disease (ESLD). This implies annual costs for the diagnosed, insured population of roughly $11.12 billion. If the diagnosed uninsured were treated like insured patients, this would add $3.23 billion. If the undiagnosed were diagnosed and treated like insured patients, this would add another $5.48 billion. Conclusions As baby boomers with HCV enter Medicare, the program may face substantial cost burdens. Proactively treating HCV patients before they suffer expensive long-term complications can help mitigate this burden to the US government. Gigi Moreno - Consulting: AbbVie Yuri Sanchez - Employment: AbbVie; Stock Shareholder: AbbVie 1069 An Actuarial View of the Aging Hepatitis C Virus (HCV) Epidemic Gabriela Dieguez 2 , Bruce Pyenson 2 , Ryan Cannon 2 , Steven Marx 1 , Yuri Sanchez 1 , Timothy R. Juday 1 ; 1 HEOR, AbbVie, Mettawa, ID; 2 Milliman, New York, NY PURPOSE In the coming years, the aging and treatment dynamics of people with chronic HCV infection may substantially shift the financial burden of health insurance coverage from private payers to Medicare. We examined shifts in the distribution of the HCV-infected population from 2015-2025 by US health insurance market, with a focus on people aging into Medicare and assuming that no patients would be cured of HCV infection. METHODS A stochastic actuarial model was developed to forecast the annual number of people with HCV insured by Medicare, Medicaid, commercial (including self-insured employers and Health Insurance Exchange enrollees), and military-associated insurance (including the Veteran Administration), as well as the number of uninsured HCV patients from 2015 to 2025. The current number of HCV patients in the major insurance markets and their annual probabilities of mortality, disability, and disease progression by age, gender, income, and HCV stage were estimated using data from Truven Health Market- Scan, Medicare 5% Sample, National Health and Nutrition Examination Survey, and Census Bureau. The expected impact of the Affordable Care Act on the HCV population’s health insurance status was considered. Prisoners were excluded from the analysis. Based on the HCV population forecast, the number of people with HCV who will gain Medicare eligibility through aging or disability in the next 10 years was calculated. RESULTS About 2.5 million non-institutionalized people in the US are estimated to be infected with HCV today. The majority of these patients are under age 65 with only 16% (405,000) covered by Medicare. This forecast predicts that, by 2025, 38% (591,000) of people with HCV in the US are expected to be eligible for Medicare, and the number of HCV patients with commercial, Medicare, or military insurance is expected to decline to less than half of the current levels. In the next 10 years, 635,000 more people with HCV will gain Medicare coverage. Furthermore, 921,000 people with HCV will die if left untreated. CONCLUSION Due to both age- and disease-related mortality, the HCV-infected population will decrease by almost 1 million over the next 10 years, assuming no treatment. By 2020, Medicare will displace commercial insurers as the largest payer for people who are currently infected with HCV. Sources: NHANES, Di Bisceglie, 2000, and Gordon 2012. Disclosures: Ron Brookmeyer - Consulting: Precision Health Economics Timothy R. Juday - Employment: AbbVie; Stock Shareholder: AbbVie Darius Lakdawalla - Consulting: AbbVie Pharmaceuticals; Stock Shareholder: Precision Health Economics Steven Marx - Employment: AbbVie; Stock Shareholder: AbbVie Disclosures: Gabriela Dieguez - Consulting: Abbvie Bruce Pyenson - Consulting: AbbVie, which funded this research, Employed by Milliman, Inc., which consults to numerous payer, providers, and suppliers to the healthcare industry, PhRMA Ryan Cannon - Consulting: Abbvie, Milliman, Inc., PhRMA Steven Marx - Employment: AbbVie; Stock Shareholder: AbbVie Yuri Sanchez - Employment: AbbVie; Stock Shareholder: AbbVie Timothy R. Juday - Employment: AbbVie; Stock Shareholder: AbbVie
HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 735A 1070 Early and persistent increase of serum cholesterol and low-density lipoprotein in chronic hepatitis C patients during IFN-free treatment Clarissa Freissmuth, Albert Stättermayer, Karin Kozbial, Sandra Beinhardt, Rafael Stern, Michael Eder, Petra E. Steindl-Munda, Michael Trauner, Peter Ferenci, Harald Hofer; Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria Background&Aims: Hepatitis C virus (HCV) is closely related to lipid metabolism. HCV genotype-(GT)-3 infection is associated with hepatic steatosis and low levels of serum cholesterol, which are reversible after successful HCV treatment. Moreover, in HCV GT-1 infection serum levels of low-density lipoprotein (LDL) particles increase on HCV clearance during sofosbuvir/ ribavirin (SOF/RBV) therapy. This study investigated serum lipid parameters in patients with HCV-1 and 3 infection undergoing IFN-free treatment. Patients&Methods: Total serum cholesterol, high density lipoprotein (HDL), LDL and serum triglycerides (TG) were analyzed at baseline, during (initially weekly, afterwards every four weeks) and after antiviral therapy in 208 patients (GT-1: N=163, age: 57±11, BMI: 26±4kg/m 2 , male/female: 99/64, F4: 108 (66%), Diabetes mellitus (DM): 35(21%)), (GT-3: N=45, age: 52±7, BMI: 26±4kg/m 2 , m/f: 32/13, F4: 34 (76%), DM: 6 (13%)). Patients with GT-3 received SOF, 400mg/d with RBV (N=24) or Daclatasvir (60mg/d) (DCV, N=21). Patients with GT-1 received SOF in combination with DCV (N=85), Simeprevir 150mg/d (N=56), 90mg/d Ledipasvir (N=20) or RBV (N=2). Results: Overall, serum cholesterol and LDL increased during treatment (table 1). This was observed after the first week of treatment (chol BL 149±36 vs. chol W1 162±41 vs. chol W2 169±40 mg/dL, mean±SD, p
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1312A AUTHOR INDEX HEPATOLOGY, Octo
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1366A CATEGORY INDEX HEPATOLOGY, Oc
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