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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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?