Although cure rates with DAAs top 97%, less than two-thirds of patients receive treatment
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Less than two-thirds of insured patients with viremic hepatitis C virus infection received treatment with direct-acting antivirals from 2014 to 2021, with a sharp decline in diagnoses and treatment reported during the COVID-19 pandemic.
“We believe that DAA treatment for HCV can improve patient clinical outcomes and survival, and that it is very safe and well-tolerated,” Mindie H. Nguyen, MD, MAS, AGAF, FAASLD, professor of medicine in the department of gastroenterology, hepatology and liver transplant at Stanford Medicine, told Healio. “However, I observed in my practice that there are still many barriers to the patient — from linkage to care or connection to a clinician who treats HCV to insurance authorization and approval of medications.”
In a retrospective cohort study published in JAMA Network Open, Nguyen and colleagues aimed to characterize patients in the U.S. with HCV using the deidentified Optum Clinformatics Data Mart Database and determine treatment rates in the DAA era (2014-2021). “Such data can inform patients, patient advocacy, clinicians and policy makers on what or how much gap we still have to encourage further efforts to fill these care gaps,” Nguyen said.
Among 133,348 identified patients (mean age, 59.7 years; 59.7% men; 56.1% white), 26.8% had HCV RNA data and, of those, 53.1% had positive HCV RNA. Overall, 65.2% of patients with positive HCV RNA results received treatment with DAAs and 97.3% achieved sustained virologic response.
Adjusted analysis showed a 0.5 times greater treatment rate in 2018 vs. 2014 (adjusted prevalence ratio = 1.5; 95% CI, 1.42-1.59), which then declined after 2018 from 64.8% to 61.2%. The treatment rate decreased to less than 60% between April 2020 to March 2021. Additionally, during the COVID-19 pandemic, only 496 patients with viremic HCV were identified. Researchers noted this was a “sizeable decrease” compared with those identified between April 2019 and March 2020 (n = 2,761) and between April 2018 and March 2019 (n = 3,258).
Patients who received care from a gastroenterologist or infectious disease specialist with an advanced care practitioner were 65% more likely to received treatment with DAAs compared with those who received care from a primary care practitioner (adjusted OR = 1.64; 95% CI, 1.38-1.95). Further, patients with decompensated cirrhosis and/or hepatocellular carcinoma were 30% less likely to receive treatment vs. patients without cirrhosis (aOR = 0.69; 95% CI, 0.54-0.9).
“In this nationwide U.S. study of insured HCV patients conducted between 2014 and 2021, we found suboptimal treatment rates for patients with viremic HCV infection, especially since the beginning of the COVID-19 pandemic,” researchers wrote. “We found a high cure rate of approximately 97% among patients treated with DAAs, regardless of what kind of clinician provided care. However, less than two-thirds of all patients with viremic HCV received DAA treatment.”
According to Nguyen, patients with positive HCV RNA tests, especially those with advanced disease such as liver cancer and decompensated cirrhosis, should be considered for treatment and referred to clinicians who are familiar with the management of these patients. “All adult patients should be screened for HCV,” she said. “Clinicians and hospital and care systems should set up reminder system to facilitate this.”
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