PIN67 - Uptake of all-oral Direct Acting Antivirals in Hepatitis C Virus-Infected Patients with Substance use Disorder

Abstract

To compare the treatment uptake with all-oral direct acting antivirals (DAA) between chronic hepatitis C virus (HCV)-inflected patients with and without substance use disorder (SUD), and to identify patient-level factors associated with DAA uptake. A retrospective cohort analysis of the Truven Health MarketScan database (2012-2015) was conducted. DAA initiation rate was calculated as the proportion initiating any kind of all-oral DAAs among newly diagnosed treatment naïve HCV patients (age>=18). A Multivariate Cox proportional hazards regression model was used to compare treatment initiation rate between HCV patients with SUD (SUD group) and without SUD (non-SUD group), and to identify patient characteristics associated with DAA uptake. We identified a total of 21,233 newly diagnosed HCV patients. Of this, 32% of HCV patients (n=6,871) had diagnosis of SUD. HCV patients with SUD were younger (24% of SUD group vs 6% of non-SUD group <=35 years old). For SUD group, the DAA initiation rate was 21%, which was significantly lower compared with non-SUD group (30%) (P<0.001). The mean days to the DAA initiation was 831 days for SUD group, which was significantly longer than non-SUD group (777 days) (P<0.001). SUD group was 25% less likely to initiate DAAs compared to non-SUD cohort (hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.70-0.80). Other factors associated with a significantly lower probability of initiating DAAs included: being younger (age <=35) (HR, 0.72; 95%CI, 0.65-0.80), being female (HR, 0.89; 95%CI, 0.85-0.94), and comorbidities including Hepatitis B virus (HR, 0.46; 95%CI, 0.35-0.61) and pregnancy (HR, 0.37; 95% CI, 0.24-0.56). Despite effective the all-oral DAA therapies now available, HCV treatment update is significantly lower in HCV patients with SUD compared to those without SUD. More research is needed to identify barriers to treating HCV-infected SUDs to improve the linkage to curative HCV treatment in this population.