Health Care Resource Utilization and Costs Associated with US Medicaid Sobriety Restrictions on Direct-Acting Antivirals for Hepatitis C Virus: A Retrospective Claims Database Analysis

Michelle T. Martin, Krithika Rajagopalan (), Dilip Makhija, Fatema Turkistani, Caroline Burk, Marvin Rock, Alice Hsiao and Nancy Reau
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Michelle T. Martin: University of Illinois Chicago Retzky College of Pharmacy
Krithika Rajagopalan: Anlitiks, Inc.
Dilip Makhija: Gilead Sciences, Inc.
Fatema Turkistani: Former employee of Anlitiks, Inc.
Caroline Burk: Gilead Sciences, Inc.
Marvin Rock: Gilead Sciences, Inc.
Alice Hsiao: Gilead Sciences, Inc.
Nancy Reau: Rush University Medical Center

PharmacoEconomics, 2025, vol. 43, issue 9, No 6, 1109-1122

Abstract: Abstract Background and Aims Many state Medicaid programs implemented sobriety restrictions that delay timely initiation of direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) infections. This claims database study examined the economic impact of sobriety restrictions on DAAs among Medicaid-insured patients with HCV. Methods A retrospective database analysis of the Anlitiks All Payor Claims data (APCD) during the period January 1, 2020 to June 30, 2022 was conducted. Continuously enrolled adult (aged 18–64 years) Medicaid-insured patients with HCV who initiated DAAs (i.e., index date) during the period January 1, 2021 to December 31, 2021 with ≥ 12 months pre-index and ≥ 6 months post-index follow-up were categorized into two cohorts (states with sobriety restriction [SR] and states with no sobriety restriction [NSR]) based on the sobriety restriction status in the state of residence on the index date. Measures analyzed were the proportion of patients with one or more all-cause medical health care resource utilization (HCRU) (inpatient hospitalization [IP], emergency department [ED], outpatient [OP], professional office [PV], and other [OV] visits) and mean per-patient medical, pharmacy, and overall costs. HCRU and cost differences were compared using adjusted multivariable logistic and gamma-log link regression models, respectively. Results Patients in the SR (n = 2,295) versus NSR (n = 4,623) cohort had a higher mean age (45 ± 12.02 vs. 43 ± 11.51 years), fewer males (50.28% vs. 58.1%), and they had lower substance use rates (44.10% vs. 59.68%), all significant at p

Date: 2025
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DOI: 10.1007/s40273-025-01487-y

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