The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially Insured Population. (2nd September 2022)

• Record Type: Journal Article
• Authors: Ferrante, Nicole D; Newcomb, Craig W; Forde, Kimberly A; Leonard, Charles E; Torgersen, Jessie; Linas, Benjamin P; Rowan, Sarah E; Wyles, David L; Kostman, Jay; Trooskin, Stacey B; Lo Re, Vincent
• Is Part Of: Open forum infectious diseases. Volume 9:Number 9(2022)
• Publication Date: 2022-09-02
• Subjects: hepatitis C elimination -- HIV/HCV coinfection -- cascade of care -- health claims database -- hepatitis C monitoring; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac445
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States. Methods: We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure. Results: Among 120, 311 individuals estimated to have HCV viremia in Optum during the study period, 109, 233 (90.8%; 95% CI, 90.6%–91.0%) had a recorded diagnosis of HCV infection, 75, 549 (62.8%; 95% CI, 62.5%–63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41, 102 (34.2%; 95% CI, 33.9%–34.4%) were dispensed DAA treatment, and 25, 760 (21.4%; 95% CI, 21.2%–21.6%) were assessed for cure. Conclusions: Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals. Abstract : Between January 2014 and 2019 in a commercially-insured population, the HCV care cascade shifted toward higher diagnosis, but only 34% of individuals estimated to have HCV viremia were dispensed direct-acting antiviral therapy. Gaps in HCV treatment remain that will make it difficult to achieve national HCV elimination goals.