Washington's Hepatitis C Plan Boosts Testing, Slashes Per-Patient Costs Over 45%

Just under 22 years following the identification of the hepatitis C virus (HCV), highly potent and rapid treatments emerged on the market. These contemporary medications achieve cure rates exceeding 95% for hepatitis C infections, yet the virus continues to pose a major challenge to public health. I

Just under 22 years following the identification of the hepatitis C virus (HCV), highly potent and rapid treatments emerged on the market. These contemporary medications achieve cure rates exceeding 95% for hepatitis C infections, yet the virus continues to pose a major challenge to public health. In the United States, it stands as the leading bloodborne disease, with a disproportionate burden on individuals from low-income backgrounds and underserved populations.

In 2018, then-Governor Jay Inslee issued a directive with the goal of eradicating hepatitis C within Washington state by the year 2030. This pioneering strategy, the first of its kind nationwide, emphasized collaboration among public health organizations, enhanced screening efforts, elimination of access obstacles, and innovative methods for acquiring antiviral drugs at reduced prices.

A recent investigation spearheaded by researchers at the University of Washington reveals that this comprehensive plan has not only broadened access to diagnostic testing and therapies but also generated substantial long-term financial savings. Detailed in JAMA Network Open, the analysis indicates that while overall expenditures for hepatitis C management initially surged upon the program's launch, they have subsequently decreased, even as heightened screening detects additional infections.

"By examining extensive health insurance claims datasets, we gain valuable insights into evolving trends in testing volumes, treatment uptake, and healthcare expenditures over time within a vast population," explained lead researcher Ashley Tabah, who contributed to the study during her doctoral program at the University of Washington. "Such data empowers states to evaluate the broader implications of programs designed to improve care access, benefiting both individuals and the healthcare infrastructure."

Collaborating closely with the Washington State Health Care Authority and the Washington State Department of Health, the research team reviewed medical claims records spanning from January 2017 to September 2022. This dataset encompassed both medical and pharmaceutical claims from private insurers and public funding sources, covering roughly 70% of the state's population—equivalent to 6 to 8 million people annually.

The findings highlighted a dramatic rise in the volume of HCV tests conducted after the elimination program took effect. Testing averaged 28,375 procedures per month toward the close of 2017, reaching a high of 99,161 tests in July 2020. Subsequently, monthly testing stabilized at around 55,844 through 2021. These fluctuations corresponded with updated national recommendations urging at least one HCV screening for every adult. As screening intensified, the study documented an early uptick in diagnosed HCV cases, followed by a notable downturn as treatments addressed more infections effectively.

Furthermore, aggregate costs associated with HCV care experienced an immediate escalation post-initiative but later retreated toward baseline figures. Monthly expenditures climbed from $45.6 million in 2017 to $70.8 million in 2019—a rise linked by the researchers to the broader detection of cases requiring intervention through expanded testing. By 2021, these costs had moderated to $56.8 million per month.

Although overall HCV-related spending increased, the expense per affected patient plummeted by more than 45%. The researchers propose that this per-patient reduction stems from proactive screening identifying infections in healthier individuals, which typically leads to superior treatment results and mitigates long-term complications and risks.

"Given the observational nature of this research, we cannot conclusively link the observed shifts directly to the state's program," noted co-author Pamela Kohler, a University of Washington professor specializing in global health and child, family, and population health nursing. "Nevertheless, the evidence strongly suggests that prioritizing screening and treatment in asymptomatic, healthy individuals proves more economically viable than delaying intervention until illness progresses."