Abstract and Introduction
Abstract
Although current guidelines recommend that nearly all patients with chronic hepatitis C virus (HCV) infection receive treatment, a substantial proportion remain untreated. We conducted an administrative claims analysis to provide real-world data on treatment patterns and characteristics of treated versus untreated patients among individuals with HCV in the United States. Adults with an HCV diagnosis from 01 July 2016 through 30 September 2020 and continuous health plan enrolment for 12 months before and ≥1 month after the diagnosis date were identified in the Optum Research Database. Descriptive and multivariable analyses were conducted to evaluate the association between patient characteristics and the rate of treatment. Of 24,374 patients identified with HCV, only 30% initiated treatment during follow-up. Factors associated with increased rate of treatment included younger age versus age 75+ (hazard ratio [HR] 1.50–1.83 depending on age group), commercial versus Medicare insurance (HR 1.32), and diagnosis by a specialist versus a primary care physician (HR 2.56 and 2.62 for gastroenterology and infectious disease or hepatology, respectively) (p < .01 for all). Several baseline comorbidities were associated with decreased rate of treatment, including psychiatric disorders (HR 0.87), drug use disorders (HR 0.85) and cirrhosis (HR 0.42) (p < .01 for all). These findings highlight existing HCV treatment inequities, particularly among older patients and those with psychiatric disorders, substance use disorders or chronic comorbidities. Targeted efforts to increase treatment uptake in these populations could mitigate a considerable future burden of HCV-related morbidity, mortality and healthcare costs.
Introduction
The development of oral direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection has provided treatment options with improved safety, tolerability and efficacy compared with older interferon-based regimens.[1,2] These new DAAs have rates of sustained virologic response (SVR) that exceed 95%,[2] suggesting that the end goal of eliminating HCV is theoretically within reach.[3]
With the advent of curative antiviral regimens, current guidelines from American and European liver societies now recommend treatment of all individuals with chronic HCV infection, excepting those who have a short life expectancy due to non-liver–related conditions.[4,5] Unfortunately, a substantial proportion of patients with chronic HCV remain untreated despite this guidance. Recent US studies indicate that less than 30% of patients with chronic HCV infection initiate treatment.[6,7]
Given the demonstrated benefits of successful HCV treatment—including lower all-cause mortality and reduced rates of cirrhosis and HCC[8]—improved understanding of factors that contribute to inequities in treatment access among patients with chronic HCV has been an area of active research. African American or Hispanic race/ethnicity,[9–11] for example, is among those characteristics that have been associated with lower rate of receiving treatment for chronic HCV, in addition to reduced access to medical care,[10] drug/alcohol use disorders[6,9–12] and comorbidity burden.[9] However, previous analyses of this topic were generally limited to particular geographical regions or hospital systems. The objective of the present study was to provide real-world data on rates of treatment initiation, treatment patterns and characteristics associated with receipt of treatment among patients diagnosed with HCV using an administrative claims database including over 71 million patients and spanning multiple healthcare provider networks across the United States.
J Viral Hepat. 2023;30(9):756-764. © 2023 Blackwell Publishing
