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Blacks, young women with HCV less likely to receive DAA therapy
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Younger women and blacks with hepatitis C virus infection who received care at Veterans Affairs facilities were less likely to receive direct-acting antivirals than other patient groups, according to a recent cohort analysis.
“Disparities by race and gender often mar the introduction of innovative or costly medical technologies as they emerge, and these disparities can persist for years,” Fasiha Kanwal, MD, MSHS, VA investigator and associate professor of medicine, gastroenterology and hepatology at Baylor College of Medicine, and colleagues wrote.
Fasiha Kanwal
“Unlike the previous interferon-containing regimens, data from registration trials show that current regimens are equally efficacious in all subgroups, regardless of patients’ race or gender. Thus, it is plausible that the availability of the new (second-generation) [direct-acting antivirals (DAAs)] might have reduced the pre-existing disparities in HCV treatment.”
To identify any such gender or racial disparities since the widespread adoption of improved DAAs, Kanwal and colleagues examined patient data from the VA Corporate Data Warehouse, a compendium of test results, procedure and diagnosis codes related to outpatient and inpatient utilization, demographics, vital status and pharmacy utilization data collected by the agency. The researchers built a cohort consisting of all adult patients with a positive HCV RNA test from 1999 to 2013 who had active viremia before Dec. 1, 2013, and had more than one recorded visit to a VA facility in 2014. Kanwal and colleagues examined the impact of race and gender on the receipt of second-generation DAAs from Dec. 1, 2013 to April 16, 2015, after adjusting for a wide range of demographic factors and comorbidities. They conducted a similar secondary analysis to identify previous receipt of boceprevir or telaprevir combined with pegylated interferon a within the same population.
There were 145,596 patients who met study criteria and were included in the analysis. The mean age of patients was 60 years; 47.8% were white, 37% were black, and 3.3% were women. Nearly all patients were seen in a primary care clinic, and many had evidence of physical and mental health comorbidities.
Approximately 10% of the cohort had filled prescriptions for second-generation DAAs during the first 16 months after approval. Receipt of treatment was lowest among blacks (8.2%), who were found to be 21% less likely to receive DAAs than whites after adjustment (OR = 0.79; 95% CI, 0.75-0.84). No differences were seen among genders. Patients who were depressed, homeless, had a history of substance abuse or had other medical comorbidities were less likely to receive DAAs, while those with cirrhosis, prior HCV or HIV were more likely to receive treatment. These findings were largely unchanged when analyzing by subgroup; however, younger women were 29% less likely to receive DAAs than younger men (OR = 0.71; 95% CI, 0.54-0.93). Results from the secondary analysis of first-generation DAA uptake were generally similar to those of the primary study.
According to the researchers, these data suggests that the disparity in treatment among blacks could be due to the increased prevalence of other predicting characteristics, as opposed to unequal access to care. However, increased efforts will be needed to provide coverage for these underserved demographics, they wrote.
“We found that African-American patients and younger women were less likely to receive the new DAAs, although the racial gap may be closing with the wide dissemination of treatment,” Kanwal and colleagues wrote. “Dedicated programs to improve treatment among patients seen in HCV specialty clinics, particularly those targeting African-American patients and young females, could potentially expedite and fully eliminate the residual disparities.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
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