Utilization and Antiviral Therapy in Patients with Chronic Hepatitis C: Analysis of Ambulatory Care Visits in the US
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Studies on mostly veterans found the majority of chronic hepatitis C (CHC) patients were not treated. Little information exists on a broad-based population.
To determine the national trend of ambulatory visits with a diagnosis of hepatitis C and the prescription of antiviral therapy associated with such visits.
Retrospective analysis of national cross-sectional databases, the National Ambulatory Medical Care Survey (NAMCS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) encompassing all ambulatory visits from 2000 to 2006.
During the study period, 16.5 million visits (0.21% of all visits) carried a diagnosis of hepatitis C and the number initially increased. Characteristics of the hepatitis C patients were: 65% male; 71% white, 22% black; 69% ≥45 years old. Overall, 47% had private insurance, 24% had Medicaid, and 12% had Medicare. Only 9.1% of these patients were prescribed antiviral treatment for CHC. There was no significant difference between those who received treatment and those who did not in terms of age, gender, race, and insurance status. HIV infection, mood, substance-use disorders, and anemia were more common in the CHC group.
Less than 10% of the ambulatory visits for hepatitis C were associated with a prescription for antiviral therapy, independent of demographic and insurance status. Purposes of the clinic visits were different in the CHC group compared to the general population. The reason for the low treatment rate is not clear but deserves further investigation.
- Armstrong GL, Wasley A, Simard EP, McQuillan GM, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.
- Butt AA, Justice AC, Skanderson M, Rigsby MO, Good CB, Kwoh CK. Rate and predictors of treatment prescription for hepatitis C. Gut. 2007;56:385–389. CrossRef
- Shatin D, Schech SD, Patel K, McHutchison JG. Population-based hepatitis C surveillance and treatment in a national managed care organization. Am J Manag Care. 2004;10:250–256.
- Bobbola M, Momi J, Lim JK, Ready J, Cheung RC. Practice patterns and treatment outcomes in the management of chronic hepatitis C (CHC) in a large management care cohort. Abstract presented at the annual meeting of the American College of Gastroenterology; 2005.
- Manos M, Shvachko V, Zhao W, Murphy RC. Determinants of HCV antiviral treatment in a managed care setting. Hepatology. 2008;48:866A.
- Cherry DK, Hing E, Woodwell DA, Recher EA. National ambulatory medical care survey: 2006 Summary. National Health Statistics Reports, Number 3, August 6; 2008.
- Centers for Disease Control and Prevention. National ambulatory care survey (NAMCS) and National hospital ambulatory medical care survey (NHAMCS) lists of publications (updated 1/6/2009). http://www.cdc.gov/nchs/data/ahcd/publist-01-06-09.pdf; 2009 Accessed 8 Jan 2009.
- Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS), 2008. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp; 2009 Accessed 8 Jan 2009.
- Cheung RC, Cunningham BA, Cooper AD. Effectiveness of a screening program for hepatitis C. Dig Dis Sci. 2006;51:976–981. CrossRef
- Falck-Ytter Y, Kate H, Mullen KD, Sarbah SA, Sorescu L, McCullough AJ. Surprisingly small effect of antiviral treatment in patients with hepatitis C. Ann Intern Med. 2002;136:288–292.
- Araya V, Basi PS, Feyssa E, Malek A, et al. The majority of HCV-infected patients presenting to a large hepatology practice in an urban setting cannot be treated with pegylated interferon and ribavirin due to psychosocial factors in spite of universal health insurance access. Gastroenterology. 2009;136(Suppl 1):S2079.
- Muir AJ, Provenzale D. A descriptive evaluation of eligibility for treatment among veterans with chronic hepatitis C virus infection. J Clin Gastroenterol. 2002;34:268–271. CrossRef
- Bini EJ, Brau N, Currie S, Shen H, et al. Prospective multicenter study of eligibility for anti-viral therapy among 4,084 U.S. veterans with chronic hepatitis C infection. Am J Gastroeneterol. 2005;100:1772–1779. CrossRef
- Groom H, Dieperink E, Nelson DB, Garrard J, et al. Outcomes of a hepatitis C screening program in a large urban VA medical center. J Clin Gastroenterol. 2008;42:97–106. CrossRef
- Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2003 Summary. Advance data from vital and health statistics; no 365. 2003 NAMCS micro-data file documentation 2004 NAMCS micro-data file documentation. http://www.cdc.gov/nchs/data/ad/ad365.pdf; 2009 Accessed 8 Jan 2009.
- Yates WR, Gleason O. Hepatitis C and depression. Depress Anxiety. 1998;7:188–193. CrossRef
- El-Serag HB, Kunik M, Richardson P, et al. Psychiatric disorders among veterans with hepatitis C infection. Gastroenterology. 2002;123:476–482. CrossRef
- Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting the future healthcare burden from hepatitis C in the United States. Liver Transpl. 2003;9:331–338. CrossRef
- Myers RP, Liu M, Shaheen AA. The burden of hepatitis C infection is growing: a Canadian population-based study of hospitalization from 1994 to 2004. Can J Gastroenterol. 2008;22:381–387.
- Bruno S, Stroffolini T, Colombo M, Bollani S, et al. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology. 2007;45:579–587. CrossRef
- Veldt BJ, Heathcote JE, Wedemeyer H, Reichen J, et al. Sustained virological response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis. Ann Intern Med. 2007;147:677–684.
- John-Baptiste AA, Tomlinson G, Hsu PC, Krajden M et al. Sustained responders have better quality of life and productivity compared with treatment failure long after antiviral therapy for hepatitis C. Am J Gastroenterol. 2009 (epub ahead of print).
- George SL, Bacon BR, Brunt EM, Mihindukulasuriya KL, et al. Clinical, virological, histological, and biochemical outcomes after successful HCV therapy: a 5-year follow-up of 150 patients. Hepatology. 2009;49:729–738. CrossRef
- Butt AA, Wang X, Moore CG. Effect of hepatitis C and its treatment on survival. Hepatology. 2009;50:387–392. CrossRef
- Berenguer J, Alverez-Pellicer J, Martin PM, Lopez-Aldeguer J, et al. Sustained virological response to interferon plus ribavirin reduces liver-related complication and mortality in patients co-infected with human immunodeficiency virus and hepatitis C virus. Hepatology. 2009;50:407–413. CrossRef
- Butt AA, Khan UA, Shaikh OS, McMahon D, et al. Rates of HCV treatment eligibility among HCV-monoinfected and HCV/HIV-coinfected patients in tertiary care referral centers. HIV Clin Trials. 2009;10:25–32. CrossRef
- Butt AA, Tsevat J, Leonard AC, Shaikh OS, et al. Effect of race and HIV co-infection upon treatment prescription for hepatitis C virus. Int J Infect Dis. 2009;13:449–455. CrossRef
- Pyenson B, Fitch K, Iwasaki K. Consequences of Hepatitis C Virus (HCV): Cost of a Baby Boomer Epidemic of Liver Disease. Seattle: Milliman, 2009. Commissioned by the Vertex Pharmaceuticals Incorporated.
- Zhang H, Mehra M, DiBello J. Increase in CHC Treatment Rate in the US is a Cost-saving Strategy. Presented at the 44th annual meeting of the European Association for the Study of the Liver. Copenhagen, Denmark, April 22–26, 2009.
- Zhang H, Mehra M, DiBello J. US Hepatitis C Burden Assessment from a Transmission Model. Presented at the 44th annual meeting of the European Association for the Study of the Liver, Copenhagen, Denmark, April 22–26 2009.
- Ruhl CS, Sayer B. Summary of surveys used in the burden of digestive diseases in the United States. In: Everhart JE, ed. The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office; 2008: NIH Publication No. 09-6443, pp. 153–155.
- Utilization and Antiviral Therapy in Patients with Chronic Hepatitis C: Analysis of Ambulatory Care Visits in the US
Digestive Diseases and Sciences
Volume 55, Issue 6 , pp 1744-1751
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Chronic hepatitis C
- Antiviral therapy
- Ambulatory care
- Industry Sectors
- Author Affiliations
- 1. Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
- 2. Division of Gastroenterology and Hepatology, VA Palo Alto Health Care System (154C), 3801 Miranda Ave, Palo Alto, CA, 94304, USA
- 3. Institute of Clinical Outcomes Research and Education, Palo Alto, CA, USA