Health care costs associated with disease progression of untreated chronic hepatitis C in the United States

BACKGROUND: Despite effective direct-acting antiviral therapies, two-thirds of US patients with chronic hepatitis C remain untreated, leading to significant public health and economic challenges. However, data on the economic burden of untreated chronic hepatitis C in the direct-acting antiviral era remain limited. OBJECTIVE: To estimate health care costs related to disease progression among untreated, newly diagnosed adults with chronic hepatitis C in the United States. METHODS: We conducted a retrospective observational study using US national commercial insurance data from January 2013 to December 2023. The cohort included adults aged 18 years or older with newly diagnosed, treatment-naive, and untreated chronic hepatitis C. Patients were categorized by liver disease stage-specific periods (chronic hepatitis C, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation), defined by the earliest recorded diagnosis of each stage and censored at progression. Liver disease-related costs, defined as costs with a primary diagnosis corresponding to these stages, were estimated using a 2-part model to account for excess zero costs. All-cause costs were estimated using generalized linear models with a γ distribution. Costs were calculated per person per month in 2023 US dollars. RESULTS: < 0.001). CONCLUSIONS: These findings highlight the critical importance of early treatment to reduce health care costs and improve clinical outcomes. Early screening and treatment can prevent progression to high-cost advanced liver disease.