Spending on Hepatitis C Antivirals in the United States, 2009–2015

New hepatitis C virus (HCV) antivirals have been shown to be highly effective with minimal adverse effects, but they are costly. Little is known, however, about the impact of the new HCV antivirals on expenditures in the overall U.S. health care system or by health care sector. Thus the objective of this study was to describe HCV antiviral expenditures by agent, year, and health care sector.Retrospective cross-sectional study.QuintilesIMS National Sales Perspectives database.QuintilesIMS National Sales Perspectives data for the period of January 1, 2009, to December 31, 2015, were used to describe HCV antiviral expenditures. HCV antiviral expenditures grew each year from $78 million in 2009 to $18 billion in 2015, except during 2013 when spending on HCV drugs dropped by $684 million (41%) compared with 2012. Although most expenditures in 2009 and 2010 were for interferons, this shifted to telaprevir in 2011-2013 and sofosbuvir-containing regimens in 2014-2015. Mail service and community pharmacies were associated with most of the expenditures throughout the study period.New HCV antivirals are driving the increased expenditures for this class. Decreased expenditures in 2013 may have been secondary to delaying HCV treatment until new therapies received approval from the U.S. Food and Drug Administration (termed "warehousing"). With continued drug development and approval of HCV therapies, expenditures are expected to continue to increase, barring actions by payers that may impede this trend. Medication policies guiding HCV treatment should focus on safety and efficacy while balancing the long-term costs of HCV.