In a large retrospective cohort study, researchers found that Medicaid beneficiaries had lower rates of hepatitis C (HCV) treatment initiation overall and varied by demographic characteristics and comorbidities.
The findings were published in JAMA Network Open.1
Specifically, the researchers found significant differences in treatment initiation rates among people younger than 30 years old, women, Hispanics and Asians, and people who inject drugs (PWID).
In contrast, those who initiate HCV treatment are usually older men.
“Of the 161,623 patients diagnosed with HCV during the study period, 87,652 patients were included in the final analysis. Of the included patients, 43 078 (49%) were female and 12 355 (14%) were aged 18 to 29 years , 35,181 (40%) were 30 to 49 years old, 51,282 (46%) were non-Hispanic White, and 48,840 (49%) had an IDU (injection drug use) diagnosis. In addition, 17,927 patients (20% ) received HCV treatment within 6 months of HCV diagnosis,” the researchers wrote.
The primary outcome of the study was initiation of direct-acting antiviral (DAA) therapy in patients diagnosed with HCV. DAA is a first-line treatment, and the researchers looked at prescriptions for DAA taken within 6 months of the date of diagnosis.They said they chose the shorter interval for 3 reasons: including recommending treatment for everyone at the time of diagnosis; case definition requiring a test followed by ICD Diagnosis codes, already account for the lag time between testing, diagnosis, and recognition of diagnosis; they say this reduces the amount of sample attrition associated with Medicaid disenrollment.
Investigators reviewed Medicaid claims from 2017 to 2019 in 50 states, Washington, D.C., and Puerto Rico. Study subjects were aged 18 to 64 years and newly diagnosed with hepatitis C.
Learning points
DDA therapy can cure HCV but remains underutilized. This study suggests that public health officials and clinicians can develop educational programs targeting specific populations and people with specific comorbidities (IDUs) to increase uptake of treatment.
“Treatment initiation rates are significantly lower among younger people. Similarly, treatment rates are lower among people who inject drugs with a diagnosis or treatment prompt. Young people who inject drugs are a priority group for elimination programs because there are several barriers to treatment, including HCV severity lower, longer symptom-free periods, lower engagement in health care, stigma, socioeconomic instability, and policies that limit treatment coverage to patients with severe disease or documented sobriety.”
“These findings suggest that interventions are needed to increase hepatitis C treatment rates overall and in key populations and to ensure equity of treatment within the Medicaid program,” the researchers wrote.
This article was originally published on Contagion Live.