Interferon-Free Regimens for Chronic Hepatitis C: Barriers Due to Treatment Candidacy and Insurance Coverage
- 367 Downloads
Recently developed interferon- and ribavirin-free regimens to treat hepatitis C virus infection (HCV) have low side effect profile accompanied by high efficacy.
To assess the potential access to these regimens using the most recent data on candidacy and insurance coverage for HCV-positive Americans.
The National Health and Nutrition Examination Survey (NHANES) cycles 2005–2008 and 2009–2012 were used in this cross-sectional study.
A total of 10,799 and 11,840 adult (18+) NHANES participants were included from the two cycles, respectively. Of these, 1.19 and 0.94 %, respectively, showed detectable viremia (HCV+). The proportion of HCV+ individuals aged ≥65 increased from 1.7 to 6.8 % (p = 0.0144). HCV+ individuals were less likely to be insured than HCV− regardless of the study year (HCV+: 63.8 % vs. HCV−: 80.1 %, p = 0.0005). Between the study cycles, the rates of insurance coverage (60.2 and 67.4 %, respectively) and treatment eligibility based on medical contraindications for interferon-based treatment (66.6 and 74.1 %, respectively) were not different (p > 0.05). With minimal contraindications for interferon- and ribavirin-free treatment, 95.1 and 97.7 % of HCV+ patients could be eligible for treatment despite aging of the study population and unchanged rates of comorbid conditions. Considering both treatment eligibility and insurance coverage, potential access to anti-HCV treatment increased from 35.1 % for interferon-based to 66.6 % for interferon-free regimens (p = 0.0003).
A large proportion of HCV+ individuals remain uninsured or under-insured. The lack of adequate coverage limits their access to the newly developed interferon- and ribavirin-free regimens for HCV that are highly effective with minimal contraindications.
KeywordsHepatitis C Interferon Direct-acting antiviral agents Health services accessibility
This research was partially supported by the Beatty Liver and Obesity Research Fund and the Outcomes Research Fund of the Inova Health System (Falls Church, VA, USA).
This article does not contain any studies with human participants or animals performed by any of the authors.
Conflict of interest
- 5.The American Association for the Study of Liver Diseases. Recommendations for testing, managing, and treating hepatitis C. Revised Aug 11, 2014. Accessed from http://www.hcvguidelines.org on August 24, 2014.
- 7.McKinsey Center for U.S. Health System Reform. Individual market: insights into consumer behavior at the end of open enrollment. Downloaded from http://healthcare.mckinsey.com/individual-market-insights-consumer-behavior-end-open-enrollment on September 2, 2014.