Hepatitis C Treatment by Nonspecialist Providers in the Direct-acting Antiviral Era. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Kapadia, Shashi N.; Johnson, Phyllis; Marks, Kristen M.; Schackman, Bruce R.; Bao, Yuhua
• Is Part Of: Medical care. Volume 59:Issue 9(2021)
• Publication Date: 2021-09
• Subjects: hepatitis C -- primary care -- administrative data -- antiviral therapy -- propensity score; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001573
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Hepatitis C virus (HCV) remains under-treated in the United States and treatment by nonspecialist providers can expand access. We compare HCV treatment provision and treatment completion between nonspecialist and specialist providers. Methods: This retrospective study used claims data from the Healthcare Cost Institute from 2013 to 2017. We identified providers who prescribed HCV therapy between 2013 and 2017, and patients enrolled in private insurance or Medicare Advantage who had pharmacy claims for HCV treatment. We measured HCV treatment completion, determined based on prescription fills for the minimum expected duration of the antiviral regimen. Using propensity score–weighted regression, we compared the likelihood of early treatment discontinuation by the type of treating provider. Results: The number of providers prescribing HCV treatment peaked in 2015 and then declined. The majority were gastroenterologists, although the proportion of general medicine providers increased to 17% by 2017. Among the 23, 463 patients analyzed, 1008 (4%) discontinued before the expected minimum duration. In the propensity score–weighted analysis, patients treated by general medicine physicians had similar odds of treatment discontinuation compared with those treated by gastroenterologists [odds ratio (OR)=1.00, 95% confidence interval (CI): 0.99–1.01, P =0.45]. Results were similar when comparing gastroenterologists to nonphysician providers (OR=1.00, 95% CI: 0.99–1.01, P =0.53) and infectious diseases specialists (OR=1.00, 95% CI: 0.99–1.01, P =0.71). Conclusions: HCV treatment providers remain primarily gastroenterologists, even in the current simplified treatment era. Patients receiving treatment from general medicine or nonphysician providers had a similar likelihood of treatment completion, suggesting that removing barriers to the scale-up of treatment by nonspecialists may help close treatment gaps for hepatitis C. Abstract : Supplemental Digital Content is available in the text.