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Hepatitis C Treatment Initiation Among US Medicaid Enrollees
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August 4, 2023
The findings revealed that treatment uptake rates were even lower among people under 30, women, Hispanic and Asian individuals, as well as people who inject drugs. The research underscores the urgent need for public health and policy efforts to improve initiation and reduce treatment disparities in Medicaid beneficiaries.
"Direct-acting antiviral treatments for hepatitis C infection introduced in the past decade achieved cure rates consistently higher than 90 percent in clinical trials and are well tolerated," said lead study author Dr. Shashi Kapadia, an assistant professor of medicine in the Division of Infectious Diseases and of population health sciences at Weill Cornell Medicine. "However, we're nowhere close to reducing the burden of hepatitis C in the United States and are falling well short of the WHO target to eliminate HCV by 2030."
The analysis revealed only 20 percent, about 18,000 of approximately 87,500 Medicaid enrollees diagnosed with HCV, began treatment within six months. Treatment uptake rates were significantly lower among particular groups: 17 percent for women compared with 23 percent for men, 14 percent for those ages 18 to 29 compared with 24 percent for those 50 to 64, and 18 percent for people with a history of injection drug use compared with 23 percent for those with no history of injection drug use. Treatment rates were also lower for Asian and Native Americans at 17 percent and 16 percent, respectively, compared with 20 percent for non-Hispanic white people. After adjusting for the influence of other clinical and sociodemographic factors, they also found lower treatment rates among Hispanic individuals compared to non-Hispanic white individuals.
Key Points
Question Are there disparities in the initiation of hepatitis C treatment among Medicaid enrollees?
Findings: In this retrospective cohort study of 87 652 US Medicaid enrollees, there was low treatment uptake for hepatitis C overall and significantly lower treatment initiation among people younger than 30 years, females, Hispanic and Asian individuals, and people with injection drug use.
Meaning: These findings suggest that interventions are needed to increase treatment rates for hepatitis C overall and among key populations and ensure equity in treatment within the Medicaid program.
Abstract
Importance: Direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is highly effective but remains underused. Understanding disparities in the delivery of DAAs is important for HCV elimination planning and designing interventions to promote equitable treatment.
Objective: To examine variations in the receipt of DAA in the 6 months following a new HCV diagnosis.
Design, Setting, and Participants: This retrospective cohort study used national Medicaid claims from 2017 to 2019 from 50 states, Washington DC, and Puerto Rico. Individuals aged 18 to 64 years with a new diagnosis of HCV in 2018 were included. A new diagnosis was defined as a claim for an HCV RNA test followed by an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code, after a 1-year lookback period.
Main Outcomes and Measure:s Outcome was receipt of a DAA prescription within 6 months of diagnosis. Logistic regression was used to examine demographic factors and ICD-10–identified comorbidities associated with treatment initiation.
Results: Among 87 652 individuals, 43 078 (49%) were females, 12 355 (14%) were age 18 to 29 years, 35 181 (40%) age 30 to 49, 51 282 (46%) were non-Hispanic White, and 48 840 (49%) had an injection drug use diagnosis. Of these individuals, 17 927 (20%) received DAAs within 6 months of their first HCV diagnosis. In the regression analyses, male sex was associated with increased treatment initiation (OR, 1.24; 95% CI, 1.16-1.33). Being age 18 to 29 years (OR, 0.65; 95% CI, 0.50-0.85) and injection drug use (OR, 0.84; 95% CI, 0.75-0.94) were associated with decreased treatment initiation. After adjustment for state fixed effects, Asian race (OR, 0.50; 95% CI, 0.40-0.64), American Indian or Alaska Native race (OR, 0.68; 95% CI, 0.55-0.84), and Hispanic ethnicity (OR, 0.81; 95% CI, 0.71-0.93) were associated with decreased treatment initiation. Adjustment for state Medicaid policy did not attenuate the racial or ethnic disparities.
Conclusions: In this retrospective cohort study, HCV treatment initiation was low among Medicaid beneficiaries and varied by demographic characteristics and comorbidities. Interventions are needed to increase HCV treatment uptake among Medicaid beneficiaries and to address disparities in treatment among key populations, including younger individuals, females, individuals from minoritized racial and ethnic groups, and people who inject drugs.
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