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Grand Rounds

What Are the Barriers to Hepatitis C Antiviral Treatment in the US?

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BACKGROUND AND PURPOSE:

  • Direct-acting antiviral (DAA) treatment is a highly effective treatment for hepatitis C (HCV), curing over 95% of cases
  • However, treatment rates remain generally low
  • Thompson et al. (CDC MMWR, 2022) assessed barriers to HCV treatment

METHODS:

  • Retrospective cohort study
    • Diagnosed with HCV between 2019 and 2020
    • Continuously enrolled in insurance for ≥60 days before and ≥360 days after diagnosis
  • Population
    • 18 to 69 years
    • HCV infection
  • Study design
    • Multivariable logistic regression used to assess the association between initiation of DAA treatment and
      • Sex | Age | Race | Payor | Medicaid restriction status
    • Medicaid treatment restrictions definitions defined as state Medicaid programs imposing any of three restrictions prior to DAA authorization
      • Presence of liver fibrosis meeting fibrosis stage criteria
      • Mandated sobriety or abstinence from alcohol or drugs (≥1 month)
      • Requirement for prescription by or in consultation with a specialist
  • Primary outcome
    • Receipt of DAA

RESULTS:

  • 47,687 adults
  • Prevalence of DAA treatment initiation within 360 days of the first positive HCV RNA test
    • Medicaid: 23%
    • Medicare: 28%
    • Private insurance: 35%
  • Prevalence of treatment initiation within 180 days of diagnosis
    • Medicaid: 75%
    • Medicare: 77%
    • Private insurance: 84%
  • Compared to private insurance, the odds of initiating treatment was lower among patients with
    • Medicaid: aOR 0.54 (95% CI, 0.51 to 0.57)
    • Medicare: aOR 0.62 (95% CI, 0.56 to 0.68)
  • After adjusting for insurance type, and comparing to adults aged 50 to 59, treatment initiation was lowest among adults
    • 18 to 29 years
    • 30 to 39 years
  • Among Medicaid recipients, lower odds of treatment initiation were found among
    • Persons in states with Medicaid treatment restrictions (vs no restrictions)
      • aOR 0.77 (95% CI, 0.74 to 0.81)
    • Black patients (vs White patients)
      • aOR 0.73 (95% CI, 0.62 to 0.88)

CONCLUSION:

  • The rate of HCV treatment using DAA is low across the US population, despite the effectiveness of the treatment
  • Treatment rates were particularly low among patients
    • With Medicaid or Medicare
    • Who were younger (18 to 29 years)
    • Who were Black
    • Who lived in a state with Medicaid treatment restrictions
  • The authors state

Universal hepatitis C screening coupled with simplified treatment protocols should be integrated into primary care and other settings serving persons with hepatitis C, and the number of primary care providers treating hepatitis C expanded, especially Medicaid providers serving populations disproportionately affected by hepatitis C

Increasing access to hepatitis C treatment to all populations, regardless of insurance type, is essential to reducing viral hepatitis–related disparities and achieving hepatitis C elimination

Learn More – Primary Sources:

Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020

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Related ObG Topics:

Is Universal Prenatal HCV Screening Cost-Effective?
What is the Rate of HCV Vertical Transmission?
What is the Effect of Hepatitis C on Fertility and Pregnancy Outcomes?

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