HCV outcomes worse for patients with public insurance, Medicaid

WASHINGTON — In this exclusive video perspective from Digestive Disease Week 2018, Zobair M. Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital in Virginia, discusses insurance coverage and mortality in patients with hepatitis C in the U.S.

“Patients with hepatitis C have different demographics ... and certain ethnic groups, as well as those that are uninsured. When you look at the type of insurance patients with hepatitis C have, they were more uninsured and had higher rates of public insurance than private,” Younossi told Healio Gastroenterology and Liver Disease.

Specifically, patients with public insurance had an HCV prevalence of 1.74% vs. 0.97% in those with private insurance (P < .05), and uninsured patients had even higher prevalence at 2.47% vs. private insurance (P < .05).

“The bottom line of this study is that when you run multivariate analysis, you compare public to private insurance with hepatitis C, those patients who have public insurance have independently higher mortality,” he continued. “When you dig deeper, you find those are the patients who have Medicaid.”

After adjusting for confounders, the researchers found that the presence of HCV significantly and independently increased mortality (HR = 2.04; 95% 1.17-3.35), especially among patients with Medicaid (HR = 9.64; 95% CI, 1.66-55.97).

“There are actually Medicaid programs in that access to care, access to medication is pretty easy, and then there are ones that have quite a bit of restriction,” Younossi said. “The plea that we have for policy makers is to provide additional funding to the Medicaid programs across the country so that these patients who are at high risk of not only having hepatitis C but have high risk of mortality should be provided these life-saving drugs.”

Reference:

Bush H, et al. Abstract 881. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosure: Younossi reports financial and advisory connections with Allergan, Bristol-Myers Squibb, Gilead Sciences, Intercept and Novo Nordisk. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.