Less than one-third of people with hepatitis C get timely treatment
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New data from a CDC Vital Signs report show that less than one-third of people with hepatitis C receive treatment within 1 year of their diagnosis despite the availability of direct-acting antivirals.
“Roughly 1% of the U.S. adult population has hepatitis C. It is a leading cause of death in the U.S., contributing to the deaths of about 14,000 people each year,” CDC Acting Principal Deputy Director Debra E. Houry, MD, MPH, said during a press briefing.
Houry said the number of new HCV infections in the U.S. has steadily increased since 2010, which she said is “another dire outcome of our nation's opioid crisis.”
“Given this growing burden, it is critical that we understand how to reach more people with hepatitis C treatment, including people with substance use disorder, to save lives and to prevent the ongoing spread of this serious infection,” Houry said.
Researchers used data from HealthVerity — an administrative claims and encounters database — to construct a cohort of adults aged 18 to 69 years with HCV infection who were diagnosed between Jan. 30, 2019, and Oct. 31, 2020. All the participants were continuously enrolled in insurance for 60 days or more before and 360 days or more after diagnosis. The researchers used modeling to assess the association between initiation of direct-acting antiviral (DAA) treatment and sex, age, race, payor and Medicaid restriction status.
Overall, they found that the prevalence of DAA treatment initiation within 360 days of the first positive HCV RNA test result among Medicaid, Medicare and private insurance recipients was 23%, 28% and 35%, respectively. Among those treated, 75% of Medicaid recipients, 77% of Medicare recipients and 84% of private insurance recipients initiated treatment within 180 days of diagnosis.
“Of particular concern was the finding that not all types of insurance are equal,” Carolyn Wester, MD, MPH, Director of CDC’s Division of Viral Hepatitis, said during the briefing.
According to the study, adjusted odds of treatment initiation were lower among those with Medicaid (adjusted OR = 0.54; 95% CI, 0.51-0.57) and Medicare (aOR = 0.62; 95% CI, 0.56-0.68) than among those with private insurance.
“Such disparities could be driven by health system barriers to patient access, lack of provider availability, quality of care, patient distressed, stigma, or language and cultural factors,” Wester said.
After adjusting for insurance type, the study showed that treatment initiation was lowest among adults aged 18 to 29 and 30 to 39 years with Medicaid or private insurance, compared with those aged 50 to 59 years.
Among Medicaid recipients, lower odds of treatment initiation were found among those in states with Medicaid treatment restrictions (aOR = 0.77; 95% CI, 0.74-0.81) than among those in states without restrictions, and among Black or African American people (aOR = 0.93; 95% CI, 0.88-0.99) or among people with any other races not listed as white (aOR = 0.73; 95% CI, 0.62-0.88).
Wester said these findings are especially concerning in the context of higher rates of HCV-related deaths among black and Hispanic people in the U.S.
“To eliminate hepatitis C, all people including younger adults, must have access to unrestricted hepatitis C testing and treatments,” Wester said. “Fortunately, there are things that we can do right now to advance health equity and expand hepatitis C testing and treatment for all people.”
She explained that health care providers, insurers, policymakers and public health professionals should work toward first removing eligibility restrictions and preauthorization requirements that make it difficult for people with HCV to access treatment. They should also consider providing treatment where people with HCV receive other services, such as primary care offices, community clinics, syringe services programs, substance use treatment centers and correctional facilities.
“If we are going to make an impact against hepatitis C, we need to connect more people to treatment and reduce disparities and access diagnosis and treatments,” Wester said. “People shouldn't have to jump over hurdles to access lifesaving treatments.”
References:
New CDC data reveal less than a third of people diagnosed with hepatitis C receive timely treatment for the deadly, yet curable, infection. https://www.cdc.gov/media/releases/2022/s0809-hepatitis-treatment.html. Published Aug. 9, 2022. Accessed Aug. 9, 2022.
Thompson WW, et al. MMWR Morbid Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7132e1.
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