Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Hepatitis C Treatment Among Insured Adults—United States, 2019—2020.” Thompson WW, Symum H, Sandul A, et al. Morbidity and Mortality Weekly Report August 12, 2022, vol 71 (32)
What question(s) does this study address?
Despite the availability of a highly effective cure for Hepatitis C virus (HCV) infection, the CDC estimates that over 2 million adults in the United States remain infected with the virus and that untreated infection results in some 14,000 deaths annually. A recent analysis estimated that during the period of 2014-2020, only 171,000 patients were prescribed Hepatitis C treatment each year—far below the annual target of treating 260,000 persons in order to eliminate Hepatitis C virus infection in the United States. Using data from HealthVerity, a nationwide administrative claims and encounters database, these researchers assessed the number of persons who initiated treatment for Hepatitis C virus within 360 days of receiving a positive Hepatitis C RNA test during the period of January 30, 2019 to October 31, 2020. They then analyzed differences in treatment initiation by sex, age, race, insurance type, and state Medicaid restrictions.
What are the major findings of this report/article?
- During the study period (1/30/19—10/31/20), 47,687 persons with a positive Hepatitis C RNA test met the study criteria and were included in this analysis. Medicaid managed care covered 79% (37,877) of these patients, private insurance covered 13.8% (6,592), and Medicare covered 6.7% (3,218).
- The percentage of patients who initiated Hepatitis C treatment within 360 days of the first positive Hepatitis C RNA test result was highest for those with private insurance (35%), followed by Medicare (28%), and Medicaid (23%).
- Among patients who received treatment, 84% of those with private insurance received treatment within 180 days of their positive Hepatitis C RNA test, compared to 77% of Medicare patients and 75% of Medicaid patients.
- Initiation of Hepatitis C treatment was lowest among adults aged 18-29 years and 30-39 years—the same age groups that have the highest rate of new Hepatitis C infections.
- Medicaid recipients who reported “Black” or “Other” as their race had lower rates of Hepatitis C treatment initiation compared to white Medicaid recipients.
- Medicaid recipients diagnosed with Hepatitis C infection who lived in states with Medicaid Hepatitis C treatment restrictions were 23% less likely to receive timely treatment compared to Hepatitis C-infected Medicaid recipients living in states without restrictions.
What are the implications for the prevention and control of viral hepatitis?
- Even among persons with continuous insurance coverage (i.e., private insurance, Medicare, or Medicaid) a minority of persons infected with Hepatitis C virus received treatment in a timely manner. This analysis revealed that approximately one-third of those with private insurance and one quarter of those covered by Medicare or Medicaid received treatment for Hepatitis C infection within 360 days of diagnosis.
- Increasing access to Hepatitis C treatment among all infected populations is essential to reducing viral hepatitis-associated disparities and achieving elimination of Hepatitis C.
Improving timely access to Hepatitis C treatment can be advanced by removing policies that restrict access to treatment, simplifying treatment protocols and expanding the number of treatment providers, and by integrating Hepatitis C diagnosis and treatment services into primary care and other settings that serve persons at high risk for infection.