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Disparities in Access to Hepatitis C Treatment Among Arizona Medicaid Beneficiaries With Chronic Hepatitis C
Xinyi Jiang1, Hyun Jin Song1, Ching-Yuan Chang1
1Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.
Insights
Direct-acting antivirals (DAAs) increased hepatitis C virus (HCV) treatment access for Arizona Medicaid patients. However, disparities persist for Hispanic patients and those with mental illness or substance use disorders.
Area of Science:
- Hepatology
- Public Health
- Health Services Research
Background:
- High costs of direct-acting antivirals (DAAs) have limited access for hepatitis C virus (HCV) patients.
- Assessing changes in HCV treatment access and predictors post-DAA implementation is crucial.
Purpose of the Study:
- To compare HCV treatment initiation rates in the post-DAA era versus the pre-DAA era.
- To identify predictors of HCV treatment access among Arizona Medicaid beneficiaries.
Main Methods:
- Retrospective cohort study utilizing Arizona Medicaid data.
- Comparison of treatment initiation rates between pre-DAA (2008-2013) and post-DAA (2013-2018) periods.
- Multivariable logistic regression controlling for demographic and clinical variables.
Main Results:
- HCV treatment initiation increased from 7.8% in the pre-DAA to 12.6% in the post-DAA period (P <0.001).
- Relative increase in treatment initiation was greater for Black beneficiaries compared to White beneficiaries (P=0.002).
- Hispanic beneficiaries, and those with mental illness or substance use disorders, were less likely to receive treatment in the post-DAA period.
Conclusions:
- While DAA treatment increased and some disparities improved, only 13% of eligible patients received treatment.
- Persistent disparities in DAA access were observed for Hispanic patients and those with co-occurring mental illness and substance use disorders.
Background:
High costs of direct-acting antivirals (DAAs) have led to their restricted access for patients with hepatitis C virus (HCV).
Objective:
The aim was to assess how HCV treatment access and predictors of HCV treatment changed in the post-DAA period compared with pre-DAA period.
Methods:
A retrospective cohort study using Arizona Medicaid data was conducted for patients with HCV to compare treatment initiation rates between pre-DAA (January 2008-October 2013) and post-DAA (November 2013-December 2018) periods. Multivariable logistic regression was used, controlling for demographic and clinical variables.
Results:
Twenty-four thousand and ninety and 28,756 patients during the pre-DAA and post-DAA periods were identified. Overall, 12.6% were treated in the post-DAA period compared with 7.8% in the pre-DAA period ( P <0.001). The relative increase in the HCV treatment initiation rate from the pre-DAA to the post-DAA period was significant greater for Black beneficiaries compared with White beneficiaries ( P =0.002). Hispanic beneficiaries were less likely to be treated in the post-DAA period [adjusted odds ratios (aOR): 0.88; CI: 0.79-0.98] compared with White beneficiaries. Those with mental illness (aOR: 0.71; 95% CI: 0.63-0.80) and substance use disorders (aOR: 0.63; 95% CI: 0.58-0.68) were less likely to be treated in the post-DAA period.
Conclusions:
Although treatment initiation increased and disparities for Black beneficiaries compared with White beneficiaries attenuated in the post-DAA period, only 13% of Arizona Medicaid patients with HCV received DAA treatment. Disparities in DAA access remained among Hispanic patients and those with mental illness and substance use disorders.
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