Hepatitis C: Time to Treatment Varies by Insurance Type

There are disparities among time to treatment of hepatitis C treatment with direct-acting antiviral (DAA) depending on insurance type, according to the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly (MMWR).

Investigators from the CDC created a cohort of about 2 million insured adults diagnosed with hepatitis C between January 2019 and October 2020 in order to categorize those who are receiving treatment based on sex, age, race, insurance type, and by state Medicaid treatment restrictions. The cohort included hepatitis C patients from all 50 states enrolled in private insurance plans, Medicare Advantage, or Medicaid managed care.

Treating hepatitis C with DAA is recommended for all persons with the infections, with few exceptions, the study authors noted. Left untreated, hepatitis C can lead to advanced liver disease, liver cancer, and death, they added. But while treatment with DAA can cure 95 percent of cases, the authors wrote that more than 14,000 hepatitis C-related deaths were reported in the US in 2019.

After an initial analysis, the study authors found 47,678 hepatitis C patients that met inclusion criteria. Medicaid managed care insured 79 percent of that group. DAA treatment began within 360 days of receipt of a positive hepatitis C test among people enrolled in Medicaid, Medicare, and private insurance at rates of 23 percent, 28 percent, and 35 percent, respectively, the study authors found. A majority of privately insured patients (84 percent) initiated DAA treatment within 180 days of their positive test, compared to 75 percent of Medicaid and 77 percent of Medicare recipients in that same window of time, the study authors added.

Treatment initiation was lower among Medicaid and private health insurance recipients aged 18 to 29 years, compared with patients aged 50 to 59 years. The lowest odds of DAA treatment initiation were lowest among patients aged 18 to 29 and 30 to 39 years with Medicaid, the study authors found.

“Everyone with hepatitis C should have access to lifesaving treatment, regardless of race, ethnicity, age or insurance status,” CDC Acting Principal Deputy Director Debra Houry, MD, MPH, said in a statement. “What these data tell us is that at best, only one in three people are treated within a year of being diagnosed and we must reduce the barriers and get more people treated for hepatitis C in our country. This is critical to stop preventable deaths and prevent new infections.”

When treatment initiations were analyzed by race, initiation was lowest among persons of other races (20 percent), and those missing race information (19 percent), the study authors said. Initiation was highest in all race groups among privately insured patients, but was lowest among persons with missing race information, the authors wrote.

Treatment initiation was similar among most racial groups after the study authors adjusted the analysis, they said, but Medicaid recipients who were Black or reported other races had lower prevalences of treatment relative to White Medicaid recipients. Asian patients with Medicare had higher rates of treatment initiation compared to their white counterparts, the study authors said.

Additionally, male sex was consistently linked to lower treatment initiation across all insurance types, the investigators wrote.

“Removing barriers to treatment is a critical step, as is increasing screening for hepatitis C,” Carolyn Wester, MD, MPH, director of CDC’s Division of Viral Hepatitis, said in the same statement. We estimate about 40% of people with hepatitis C in the US are unaware of their infection—testing is the first step to accessing curative treatment.”