A Descriptive Analysis of a Multidisciplinary Health Agency Providing Treatment to Uninsured Hepatitis C Patients

Abstract

Introduction: A majority of hepatitis C (HCV) patients will not receive treatment because many are uninsured and cannot afford treatment. Mercy Health Center, a small non-profit health agency, is unique in that it provides treatment at no cost to uninsured patients in its HCV clinic utilizing a multidisciplinary care model. The multidisciplinary team is comprised of a gastroenterologist, pharmacist, social worker, psychologist, nutritionist, and nurse practitioner. The objectives of this study were to describe clinical characteristics of uninsured HCV patients served by the treatment team, report treatment completion and sustained virologic response (SVR) rates, and estimate the amount of HCV medications provided at no cost to uninsured patients. Methods: A retrospective chart review was performed and identified 69 uninsured HCV patients who received medical care at Mercy Health Center between January 2008 and March 2015. Demographic, medical, psychiatric, substance use, HCV clinical characteristics, laboratory, and medication data were extracted. Chi-square, t-test, and logistic regression were used in the analysis. Results: The mean age at evaluation was 48 years with a mean birth year of 1964. Three-fourths of the patients were unemployment, a third had multiple HCV exposures, nearly half acquired HCV due to illicit drug use, and more than half had active psychiatric disorders. Most patients had medical comorbidities (87%), and the most common medical conditions were hypertension, gastroesophageal reflux disease (GERD), and diabetes. Of those who received HCV treatment, 84% successfully completed treatment and 85% achieved SVR. The agency facilitated and provided >$1.3 million of HCV antiviral therapeutics at no cost to uninsured patients. Conclusion: With appropriate support, uninsured HCV patients, who are often regarded as “difficult-to-treat” patients, can achieve HCV treatment completion and SVR rates similar to that of insured HCV patients. Liver specialists are encouraged to advocate for treatment and care for uninsured and poor HCV patients in health agencies and health systems. It is important for health systems to serve poor and uninsured HCV patients, otherwise population-wide reductions in HCV morbidity and mortality will not be realized.