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Disparities in access to care for HCV still exist despite new regimens

Despite high sustained virologic response rates from Sovaldi-based regimens in clinical practice, there are still barriers to care for adults with hepatitis C virus infection, with financial reasons being the most prevalent barrier.

Researchers, including Zobair M. Younossi, MD, MPH, chairman of the department of medicine, Inova Fairfax Hospital, and vice president for research of Inova Health System, evaluated data from 3,841 patients with HCV prescribed a sofosbuvir-containing regimen between December 2013 and September 2014. All data was retrieved from the Trio Health network, a system that compiles data from specialty pharmacies and participating physicians for disease management.  

Zobair M. Younossi

The primary endpoint of the study was to determine whether patients began treatment with a Sovaldi (sofosbuvir, Gilead Sciences)-based regimen as prescribed, and why or why not.

Overall, 8% of patients did not start the prescribed treatment (n = 315). Of these, 45% had a commercial plan as their primary insurance (n = 141), 44% had Medicaid as their primary insurance (n = 137), 5% had Medicare as primary insurance (n = 17) and 6% did not have insurance coverage or it was not specified (n = 20).

Five-percent of patients reported not starting the treatment regimen because they had been unreachable or did not complete required testing (n = 15); 12% did not start because they were following their physicians' direction to wait for new treatment options or to hold treatment for an unspecified reason (n = 39); and 81% of the patients did not start treatment due to insurance-related processes and financial reasons (n = 254). Two=percent of remaining patients had no specified reason for not beginning treatment.

“Nonstart rates were highest in the Medicaid-covered population at 35%. Medicare and commercial [insurance] nonstart rates were 2% and 6%, respectively,” the researchers wrote.

To compare the Medicaid-matched and commercial-matched patient populations, odds ratios were calculated across different demographics. From this analysis, the commercial-matched patients were 6.48 times more likely to start a sofosbuvir-based treatment regimen compared with the Medicaid-matched patients.

“As better treatment for HCV with high efficacy and low side effects rates becomes available, the Medicaid budget barrier to treatment must be resolved,” the researchers concluded. – by Melinda Stevens  

Disclosure: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.