Obstacles to successful treatment of hepatitis C in uninsured patients from a minority population

Alexandra Debose-Scarlett,Raymond Balise,Eugene R Schiff,Gladys Patricia Ayala,Deukwoo Kwon,Susan Vadaparampil,Steven Xi Chen,Emmanuel Thomas

doi:10.1186/s12967-018-1555-y

Abstract

BackgroundHepatitis C virus (HCV) treatment regimens (DAAs) are well tolerated, efficacious but costly. Their high cost and restricted availability, raises concerns about the outcome of treatment in uninsured patients. This study investigated sustained virologic response (SVR) outcomes in a predominately uninsured patient population and completion of four steps along the HCV treatment cascade.MethodsA retrospective chart review was conducted to characterize the patient population and analyze covariates to determine association with insurance status, attainment of SVR and progression through the HCV treatment cascade.ResultsOut of a total of 216 patients, 154 (71%) were uninsured. Approximately 50% of patients (109 of 216 patients) were male and 57% were Hispanic (123 of 216 patients). Sex, race, ethnicity, treatment compliance, and rates of complications were not associated with insurance status. Insured patients were older (median 60 years vs 57 years, p-value < 0.001) and had higher rates of cirrhosis: 32 out of 62 patients (52%) vs 48 out of 154 patients (31%) (p-value = 0.005). Insured patients were tested for SVR at similar rates as uninsured patients: 84% (52 of 62 patients) vs 81% (125 of 154 patients), respectively. Of those tested for SVR, the cure rate for insured patients was 98% (51 out of 52 patients) compared to 97% (121 out of 125 patients) in the uninsured. Out of those who completed treatment, 177 of 189 (94%) were tested for attainment of SVR. Compliance rates were significantly different between tested and untested patients: 88% (156 of 177 patients) vs 0% (0 of 12 patients), respectively (p-value < 0.001). However, insurance status, race ethnicity, cirrhosis, and complications were not associated with being tested for SVR.ConclusionsThese results demonstrate that insured and uninsured patients with chronic HCV infection, with access to patient assistance programs, can be treated and have comparable clinical outcomes. In addition, testing for SVR remains an important obstacle in completion of the HCV treatment cascade. Nevertheless, patient assistance programs remove a significant barrier for treatment access in real-world HCV infected populations.

Highlights

Hepatitis C virus (HCV) treatment regimens (DAAs) are well tolerated, efficacious but costly
HCV treatment in insured and uninsured patients Initially, we analyzed our data for differences in clinical covariates and treatment outcomes between insured and uninsured patients (Table 1). 216 patients were included in this study and their corresponding data was used for analysis
Our study directly addresses a key provider-level barrier to care for these patients and strengthens the recommendation that all HCV infected patients should be treated for this deadly virus infection [8]

Summary

Introduction

Hepatitis C virus (HCV) treatment regimens (DAAs) are well tolerated, efficacious but costly. Their high cost and restricted availability, raises concerns about the outcome of treatment in uninsured patients. This study investigated sustained virologic response (SVR) outcomes in a predominately uninsured patient population and com‐ pletion of four steps along the HCV treatment cascade. 85% of infections progress to chronicity [3]. Most people are unaware of their infection [7], putting them at increased risk of spreading the disease and more likely to suffer from HCV-related morbidity and mortality [3]. The identification of occult cases allows these patients to receive treatment, but decreases the risk of HCV transmission [3]

Methods

Results

Discussion

Conclusion