S1371 High SVR Rates, Regardless of Race or Socioeconomic Class, in Patients Treated With HCV DAAs in Community Practice Using a Specialized Pharmacy Team

Abstract

Introduction: Approved HCV DAA regimens can cure nearly all patients; however, socioeconomic disparities may impact access and outcome. This study assesses socioeconomic factors, differences in insurance coverage and the drug prior auth process in HCV-infected patients managed in community practices partnered with a dedicated pharmacy team with expertise in liver disease. Methods: This IRB-approved, ongoing study captures data on a cohort of 2480 patients from community practices. Patients had chronic hepatitis C and were treated with DAA regimens selected by their physician. Median income is based on home zip code. The HCV Health Outcomes Centers (HOC) Network provides comprehensive patient management including a dedicated pharmacy support team with expertise in the prior auth process. Results: In this cohort, 60.1% were male, 49% were Hispanic Whites (HW), 37% were Non-Hispanic Whites (NHW), and 14% were Black. Eighty-seven percent of patients were treatment naïve, 74% were infected with genotype 1 virus and 63% had advanced fibrosis/cirrhosis (F3/F4=68.2% HW, 65.6% Blacks, 55.4% NHW). Figure depicts the distribution of socioeconomic characteristics by racial group. Forty percent of patients were on disability with the highest % in the Black group and less than 1/3 were employed full time, regardless of race/ethnicity. Medicare covered 42% of Black patients vs 32% of HW and NHW. The vast majority of HW (80%) and Blacks (75%) had a median income below the median income of Texas residents. Additionally, 75% of HW and 71% of Blacks had median income below the poverty level in Texas. Despite the above socioeconomic factors, 92% of all prior authorizations were approved upon first submission and patients received DAAs an average of 17 days from prescription. DAA therapy resulted in cure in 95.3% of patients (SVR=94.8% HW, 94.0% Blacks, 96.5% NHW). Conclusion: Despite having more advanced disease and more negative socioeconomic factors, > 94% of HW and Blacks patients were cured. Continued patient education and communication with the healthcare team can lead to high adherence and > 94% HCV cure rates regardless of race/ethnicity or underlying socioeconomic factors in the community setting.Figure 1.: Distribution of socioeconomic characteristics by racial group.