It took less than 22 years after the discovery of the hepatitis C virus (HCV) for a fast-acting, highly effective treatment to become available. at curing hepatitis C infection, yet the virus remains a critical public health problem. It’s the most common bloodborne illness in the United States, and disproportionately impacts low-income people and marginalized communities. 

A directive aimed to eliminate the disease from Washington state by 2030. The first-in-the-nation plan called for coordination between public health agencies, increased screening, removal of barriers to care and a new approach to purchasing antiviral medications at a discount. 

A new study led by the 91���� found that the plan not only expanded access to tests and treatment, but may save money in the long run. , the study found that total costs for hepatitis C-related care rose when the program was first implemented but have declined since, even as increased screening identifies more cases. 

“Comprehensive health insurance claims data can help us see how patterns in testing, treatment and healthcare costs are changing over time across a large population,” said lead author , who worked on the study while completing a doctoral degree at the 91����. “That kind of information can help states better understand how initiatives to expand access to care may affect both patients and the healthcare system.”

Working in collaboration with the Washington State Health Care Authority and the Washington State Department of Health, researchers analyzed medical claims data between January 2017 and September 2022. Records included medical and pharmacy claims collected from both private insurance companies and public payers. The data represented about 70% of Washington residents, approximately 6-8 million individuals per year. 

Researchers found that the number of HCV tests administered increased sharply after Washington implemented the elimination initiative. There was a median of 28,375 tests per month at the end of 2017, peaking at 99,161 by July 2020. The number of tests then leveled off at a median of 55,844 per month throughout 2021. Researchers noted that these shifts also aligned with new national guidelines that recommended all adults receive at least one HCV test. Consistent with increased screening, the study observed an initial increase in the total number of HCV cases, followed by a significant decline over time as more people received treatment.

The study also found that total HCV-related costs spiked immediately after implementation of the initiative, but then dropped closer to initial levels. Total monthly costs rose from $45.6 million in 2017 to $70.8 million in 2019, an increase the researchers attributed to expanded screening, which identified more cases to treat. Monthly costs then declined to $56.8 million in 2021. 

While total HCV care costs rose, costs per patient declined by more than 45%. Researchers said the decline may be due to increased screening catching more infections in otherwise healthy people, which would likely improve treatment outcomes and reduce associated risks over time. 

“As an observational study, we cannot directly attribute the changes over time to the state initiative,” said co-author , a professor of global health and of child, family and population health nursing at the 91����. “However, it does support the idea that investing in screening and treatment of healthy people without symptoms is more cost-effective than waiting until they become sick.” 

Other authors include , professor of health economics and director of the Comparative Health Outcomes, Policy and Economics (CHOICE) Institute at the 91����; , teaching professor of biobehavioral nursing and health informatics in the 91���� School of Nursing; , assistant professor of child, family and population health nursing and of allergy and infectious diseases at the 91���� School of Medicine; , research coordinator in the Department of Child, Family and Population Health Nursing at the 91����; Judy Zerzan-Thul, Leta Evaskus, Donna Sullivan, Stella Chang and JoEllen Colson of the Washington State Health Care Authority; and Emalie Huriaux and Jon Stockton of the Washington State Department of Health.

This study was funded by the Laura and John Arnold Foundation.

Nurses and nurse-scientists interested in advanced multi-disciplinary training for population and global health practice can now apply for a new 91���� . The concurrent Doctor of Nursing Practice in Population Health and Master of Public Health in Global Health Degree is a three- to four-year program that aims to expand the skills of public health nurses and nurse scholars to work in partnership with populations and health systems to ultimately improve access to health care and help achieve health for all.

“Graduates of the new concurrent degree program will be equipped to lead sustainable change in collaboration with health systems, communities, and populations; and will have the skills to evaluate program and policy impact,” said , associate professor with the 91���� Departments of Global Health, and Psychosocial and Community Health, and Schools of Public Health and Nursing.

The doctorate program prepares registered nurses for advanced practice roles, nursing leadership and the application of evidence-informed decision-making models to nursing practice. The master’s degree in global health provides social justice and practical skills-based frameworks for achieving health equity through partnerships, with a focus on health conditions that transcend borders. Graduates of the new concurrent degree program will gain the knowledge and skills of both degrees.

“I believe that the study and understanding of population health is the future of nursing and I’m very excited that we are offering this concurrent degree. Students in this program will integrate research findings and evidence into healthcare policy and practice and they will be grounded in a deep understanding of the social, economic, and political determinants of health,” said , dean of the School of Nursing.

To earn both degrees, a student must complete two sets of degree requirements. Students must submit an application for each program, either at the same time or to the second program during their first year of study.

The 91���� School of Nursing is holding a series of through Nov. 5. Applications are now open for students to begin the program in fall quarter of 2019.

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For more information: populationhealthnursing@uw.edu or 206-543-8736.