Projected health benefits and cost offsets from the United States National Hepatitis C Elimination Initiative

Over 2 million Americans were estimated to have chronic hepatitis C virus (HCV) in 2020. The national hepatitis C elimination initiative provides an opportunity to dramatically expand access to HCV treatment nationally. Using a validated microsimulation model, we projected the health benefits and cost savings of the proposed US national hepatitis C elimination initiative compared with the status quo from 2025 to 2044. The model incorporates HCV disease progression, incidence, diagnosis, treatment, and costs across Medicare, Medicaid, privately insured, justice-involved, and uninsured populations. By 2034, the initiative is projected to reduce the number of persons with HCV to approximately 100,000, compared with 1.3 million under the status quo. Over 10 years (2025-2034), the initiative is projected to avert 20,000 cases of hepatocellular carcinoma, 49,000 cases of diabetes, 25,000 cases of chronic kidney disease, and 24,000 deaths, and add 220,000 life years. These reductions in disease would save an estimated $17.7 billion in healthcare spending, of which $12.2 billion would accrue to the federal government. Over 20 years (2025-2044), the health benefits would more than double and cost offsets would triple compared with 10-year outcomes. The national hepatitis C elimination initiative can substantially reduce HCV-related morbidity and mortality while offsetting healthcare spendings.