Low uptake of direct-acting antiviral therapy among hepatitis C patients with advanced liver disease and access to care, 2014–2017

Details

• Alternative Title:
  J Clin Gastroenterol
• Personal Author:
  Spradling, Philip R. ; Xing, Jian ; Rupp, Loralee B. ; Moorman, Anne C. ; Gordon, Stuart C. ; Lu, Mei ; Teshale, Eyasu H. ; Boscarino, Joseph A. ; Schmidt, Mark A. ; Daida, Yihe G. ; Holmberg, Scott D.
• Corporate Authors:
  Chronic Hepatitis Cohort Study (CHeCS) Investigators
• Description:
  Goals:
  
  To determine the proportion and characteristics of adults with hepatitis C at healthcare organizations in four U.S. states who initiated direct-acting antivirals (DAAs).
  
  Background:
  
  There are almost no data to assess the penetrance of treatment of the hepatitis C population in general U.S. healthcare settings.
  
  Study:
  
  We conducted a prospective observational study using electronic clinical, pharmacy, and mortality data to determine the fraction of patients who initiated DAAs between January 2014 and December 2017, by start date and regimen. We used stepwise multivariate logistic regression analysis to identify sociodemographic and clinical characteristics associated with receipt of DAAs.
  
  Results:
  
  Of 8,823 patients, 2,887 (32.7%) received DAAs. Quarterly (Q) uptake ranged from 1.1% in Q3 2014 to a high of 5.6% in Q2 2015. Characteristics associated with receipt of DAAs included age 51–70 years, higher income, pre-2014 treatment failure, and higher non-invasive fibrosis score (FIB4); however, over one-half of patients with FIB4 scores >3.25, consistent with severe liver disease, were not treated. A lower likelihood of initiation was associated with Medicaid coverage. Of 5,936 patients who did not initiate treatment, 911 (15.3%) had died and 2,774 (46.7%) had not had a clinical encounter in ≥12 months by the end of the study. Fewer than 1% of DAA prescriptions originated from non-specialty providers.
  
  Conclusion:
  
  During four calendar years of follow-up, one-third of patients initiated DAAs. Large fractions of untreated patients had advanced liver disease, died, or were lost to follow-up. Even among patients in integrated healthcare systems, receipt of DAAs was limited.
• Keywords:
  • direct-acting antivirals
  • hepatitis C
  • treatment uptake
  • Chronic Hepatitis Cohort Study
  • Adult
  • Aged
  • Antiviral Agents
  • Health Services Accessibility
  • Hepacivirus
  • Hepatitis C
  More +
• Source:
  J Clin Gastroenterol. 55(1):77-83
• Pubmed ID:
  32250999
• Pubmed Central ID:
  PMC10711731
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  55
• Issue:
  1
• Download URL:
  https://stacks.cdc.gov/view/cdc/137165/cdc_137165_DS1.pdf
• File Type:
  [PDF - 626.12 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:5e28ebd5f982d64970e1a84981b8f0391cfb2bf54e1c245f11b805976dfc1793