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Published on: December 15, 2023
Gaps and Disparities in Chronic Hepatitis B Monitoring and Treatment in the United States, 2016-2019
Thi T Hang Pham1, Mehlika Toy1, David Hutton2
1Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
Insights
Many chronic hepatitis B (CHB) patients miss recommended monitoring and treatment, including antiviral therapy. This highlights gaps in care for CHB patients, necessitating improved clinical management strategies.
Area of Science:
- Hepatology
- Viral Hepatitis
- Public Health
Background:
- Chronic hepatitis B (CHB) increases risk of cirrhosis and hepatocellular carcinoma (HCC).
- Guidelines recommend monitoring disease activity (ALT, HBV DNA, HBeAg) and HCC surveillance for at-risk CHB patients.
- Antiviral therapy is advised for CHB patients with active hepatitis and cirrhosis.
Purpose of the Study:
- To analyze monitoring and treatment patterns for adults with new CHB diagnoses.
- To identify gaps in recommended clinical care for CHB patients.
- To investigate factors associated with receiving recommended CHB assessments and therapies.
Main Methods:
- Retrospective analysis of claims data from the Optum Clinformatics Data Mart Database.
- Inclusion of adult patients with new CHB diagnoses between January 1, 2016, and December 31, 2019.
- Examination of claims for laboratory tests (ALT, HBV DNA, HBeAg), liver imaging, and antiviral therapy within 12 months of diagnosis.
Main Results:
- Only 50-56% of CHB patients received recommended laboratory monitoring.
- HCC surveillance claims were present in 57-82% of patients, varying by cirrhosis status.
- Merely 29% of cirrhotic CHB patients received antiviral therapy within 12 months of diagnosis.
- Male sex, Asian ethnicity, private insurance, and cirrhosis were associated with higher rates of recommended care.
Conclusions:
- A significant proportion of diagnosed CHB patients do not receive recommended clinical assessments and treatments.
- Barriers exist at patient, provider, and system levels impacting CHB management.
- Comprehensive initiatives are required to improve clinical care for CHB.
Background:
Chronic hepatitis B (CHB) carries an increased risk of death from cirrhosis and hepatocellular carcinoma (HCC). The American Association for the Study of Liver Diseases recommends patients with CHB receive monitoring of disease activity, including ALT, hepatitis B virus (HBV) DNA, hepatitis B e-antigen (HBeAg), and liver imaging for patients who experience an increased risk for HCC. HBV antiviral therapy is recommended for patients with active hepatitis and cirrhosis.
Methods:
Monitoring and treatment of adults with new CHB diagnoses were analyzed using Optum Clinformatics Data Mart Database claims data from January 1, 2016, to December 31, 2019.
Results:
Among 5978 patients with new CHB diagnosis, only 56% with cirrhosis and 50% without cirrhosis had claims for≥1 ALT and either HBV DNA or HBeAg test, and among patients recommended for HCC surveillance, 82% with cirrhosis and 57% without cirrhosis had claims for≥1 liver imaging within 12 months of diagnosis. Although antiviral treatment is recommended for patients with cirrhosis, only 29% of patients with cirrhosis had≥1 claim for HBV antiviral therapy within 12 months of CHB diagnosis. Multivariable analysis showed patients who were male, Asian, privately insured, or had cirrhosis were more likely (P<0.05) to receive ALT and either HBV DNA or HBeAg tests and HBV antiviral therapy within 12 months of diagnosis.
Conclusion:
Many patients diagnosed with CHB are not receiving the clinical assessment and treatment recommended. A comprehensive initiative is needed to address the patient, provider, and system-related barriers to improve the clinical management of CHB.
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