Research Article: Budgetary impact analysis of a primary care-based hepatitis C treatment program: Effects of 340B Drug Pricing Program

Date Published: March 14, 2019

Publisher: Public Library of Science

Author(s): Eric A. Jones, Benjamin P. Linas, Ve Truong, James F. Burgess, Karen E. Lasser, Dawn K. Smith.


Safety-net health systems, which serve a disproportionate share of patients at high risk for hepatitis C virus (HCV) infection, may use revenue generated by the federal drug discount pricing program, known as 340B, to support multidisciplinary care. Budgetary impacts of repealing the drug-pricing program are unknown. Our objective was to conduct a budgetary impact analysis of a multidisciplinary primary care-based HCV treatment program, with and without 340B support.

We conducted a budgetary impact analysis from the perspective of a large safety-net medical center in Boston, Massachusetts. Participants included 302 HCV-infected patients (mean age 45, 75% male, 53% white, 77% Medicaid) referred to the primary care-based HCV treatment program from 2015–2016. Main measures included costs and revenues associated with the treatment program. Our main outcomes were net cost with and without 340B Drug Pricing support.

Total program costs were $942,770, while revenues totaled $1.2 million. With the 340B Drug Pricing Program the hospital received a net revenue of $930 per patient referred to the HCV treatment program. In the absence of the 340B program, the hospital would lose $370 per patient referred. Ninety-seven percent (68/70) of patients who initiated treatment in the program achieved a sustained virologic response (SVR) at a net cost of $4,150 each, among this patient subset.

The 340B Drug Pricing Program enabled a safety-net hospital to deliver effective primary care-based HCV treatment using a multidisciplinary care team. Efforts to sustain the 340B program could enable dissemination of similar HCV treatment models elsewhere.

Partial Text

Hepatitis C virus (HCV) infection is a leading cause of morbidity and mortality in the United States [US], with prevalence estimates between 1–2% or 2.7–3.9 million individuals infected,[1] and in excess of 10,000 deaths annually.[2] Untreated, HCV infection can produce complications including cirrhosis, liver disease, and necessity for liver transplantation,[3] at significant cost.[4]

We performed a budgetary impact analysis of the Boston Medical Center HCV Primary Care Treatment Program. Assuming the cost perspective of the medical center, we followed methodological guidelines recommended by Mauskopf et al [14] to analyze resource utilization and cost data for 302 patients referred to the program during 2015–2016. Our study involved analyses of retrospective, de-identified data and posed no more than minimal risk to subjects. The Institutional Review Board at Boston University School of Medicine approved the study protocol and did not require collection of written informed consent from participants.

The 340B program enabled a safety-net hospital to deliver primary care-based HCV treatment using a multidisciplinary care team, and resulted in a net revenue of $930 per patient referred. Without the 340B program, the practice would experience a net loss of $370 per patient referred and would likely not be sustainable in resource-poor settings, which disproportionately care for HCV-infected patients. Further, if the 340B program were removed, patient adherence to treatment could decline, as the hospital might be unable to support the ancillary services provided by the case manager and pharmacist that facilitate adherence to treatment.