Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015

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:
  Background:
  
  Limited information is available describing the uptake of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection among patients in general US health care settings. We determined the proportion of HCV-infected patients in the Chronic Hepatitis Cohort Study prescribed DAAs in 2014, who initiated treatment and identified characteristics associated with treatment initiation.
  
  Methods:
  
  Uptake was defined as the proportion of HCV-infected patients with at least 1 clinical encounter in 2013 who were prescribed a DAA regimen during 2014 and initiated the regimen by August 2015. Using multivariable analysis, we examined demographic and clinical characteristics associated with receipt of DAAs.
  
  Results:
  
  The cohort comprised 9508 patients; 544 (5.7%) started a DAA regimen. Higher annual income [adjusted odds ratios (aOR) 2.3 for income > $50K vs. <$30K], higher Fibrosis-4 score (aORs, 2.1, 2.0, and 1.4 for Fibrosis-4, >5.88, 3.25 to 5.88, 2.0 to 3.25, respectively, vs. <2.0), genotype 2 infection (aOR 2.2 vs. genotype 1), pre-2014 treatment failure (aOR 2.0 vs. treatment-naive), and human immunodeficiency virus (HIV) coinfection (aOR 1.8 vs. HCV monoinfection) were associated with DAA initiation. Black race/ethnicity (aOR 0.7 vs. whites) and Medicaid coverage (aOR 0.5 vs. private insurance) were associated with noninitiation. Sex, age, comorbidity, previous liver transplant, and duration of follow-up were not associated with receipt of DAAs.
  
  Conclusions:
  
  Among patients in these general US health care settings, uptake of DAA therapy was low in 2014, and especially so among minority and Medicaid patients. Systemic efforts to improve access to DAAs for all patients are essential to reduce morbidity and mortality from HCV infection.
  
  
• Keywords:
  Adult Aged Antiviral Agents Black Or African American Chronic Hepatitis Cohort Study Coinfection Direct-acting Antivirals Drug Therapy, Combination Female Genotype Health Services Accessibility Hepacivirus Hepatitis C Hepatitis C, Chronic HIV Infections Humans Income Liver Cirrhosis Male Medicaid Middle Aged Patient Acceptance Of Health Care Risk Factors Time Factors Treatment Outcome Treatment Uptake United States White People

  More +
• Source:
  J Clin Gastroenterol. 52(7):641-647
• Pubmed ID:
  28590325
• Pubmed Central ID:
  PMC6427915
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/ ; U18 PS005154/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  52
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9fc46fed0619326e3fa3ab1d496ba01a2e61aa0a6da1450cffeb2924cf617180
• Download URL:
  https://stacks.cdc.gov/view/cdc/76743/cdc_76743_DS1.pdf
• File Type:
  [PDF - 515.59 KB ]