Hepatitis is a viral infection that causes inflammation of the liver. In the United States, the most common types of Viral Hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C. In 2020, there were an estimated 19,900 people with Hepatitis A, 80,000 people with Hepatitis B, and 2.2 million people with Hepatitis C. (Source: What is Viral Hepatitis? | CDC)

ADVI Health’s Strategic Analytics, Values and Economics (SAVEs) team wanted to better understand the prevalence of Viral Hepatitis among Medicare fee-for-service (FFS) beneficiaries and their average cost of care.

In 2021, we found 249,529 (0.7 percent of all Medicare beneficiaries) patients with Hepatitis using the Chronic Condition Data Warehouse (CCW) Chronic Conditions File. The average Medicare spending for patients with Hepatitis was three times more than the average spending of the Medicare FFS population ($44,572 vs $14,805). Figure 1 shows the Top five services with the highest average Medicare spend in 2021. The increased spending was mainly Evaluation and Management (E&M) payments and Part B and D drug spending.

This population skewed toward lower-income beneficiaries as 50 percent were low-income subsidies (LIS) and 48 percent were dually eligible for Medicare and Medicaid. Both numbers are significantly higher than the general Medicare Fee-for-service (FFS) population which are 17 percent and 16 percent respectively. 

Figure 1 – Top Five Services with the Highest Average Medicare Spending in 2021.