Association of Direct-Acting Antiviral Treatment With Mortality Among Medicare Beneficiaries With Hepatitis C

Abstract

IMPORTANCE Direct-acting antiviral (DAA) drugs are highly effective in curing hepatitis C virus (HCV) infection. Previous simulations showed extended life as a key health advantage of DAA drugs, but real-world evidence on the association between DAA treatment and reduced mortality is limited. OBJECTIVES To examine the association of DAA treatment with mortality among Medicare beneficiaries with hepatitis C. DESIGN, SETTING, AND PARTICIPANTS This cohort study used Medicare claims data of beneficiaries who sought hepatitis C care for the first time between January 1, 2014, and December 31, 2016, after at least a 1-year washout period. Medicare Part D files were used in identifying DAA therapy initiation and completion. Death dates, demographic data, and indicators of health risks were obtained from the Master Beneficiary Summary Files. Beneficiaries with hepatitis C were considered as patients with DAA treatment if they initiated DAA therapy during the study period. Beneficiaries with hepatitis C who did not initiate DAA therapy during the study period were considered as patients without DAA treatment. Patients without DAA treatment were selected using 1-to-1 propensity score matching. Data were analyzed between September 1, 2019, and March 31, 2020. EXPOSURES Completion of DAA treatment. MAIN OUTCOMES AND MEASURES Time to death from the index date of seeking hepatitis C care after at least a 1-year washout period. Cox proportional hazards regression models with time-varying exposure were used to compare mortality rates between propensity score-matched cohorts of patients with DAA treatment and those without DAA treatment. Separate analyses were performed for patients with or without cirrhosis. Heterogeneity in the association between DAA treatment and mortality by sex and dual-eligibility status was examined. RESULTS A propensity score-matched sample of 51 478 Medicare beneficiaries with a mean (SD) age of 59.4 (11.1) years and 30 473 men (59.2%) was assessed. Of this total, 8240 patients (16.0%) had cirrhosis (5224 men [63.4%]; mean [SD] age, 62.3 [9.7] years) and 43 238 patients (84.0%) had no cirrhosis (25 249 men [58.4%]; mean [SD] age, 58.8 [11.3] years). The adjusted hazard ratio (HR) of dying between patients with DAA treatment and those without DAA treatment in the cirrhosis group was 0.51 (95% CI, 0.46-0.57). The association of DAA treatment with mortality did not differ by sex (women vs men: HR, 0.46 [95% CI, 0.38-0.56] vs HR, 0.53 [95% CI, 0.47-0.60]; P = .27) or dual-eligibility status (non-dual-eligible HR, 0.52 [95% CI, 0.43-0.63] vs dual-eligible HR, 0.50 [95% CI, 0.44-0.57]; P = .80) in the cirrhosis group. The adjusted HR of dying between patients with DAA treatment and those without DAA treatment among patients without cirrhosis was 0.54 (95% CI, 0.50-0.58). The association of DAA treatment with mortality did not differ by sex (women vs men: HR, 0.53 [95% CI, 0.46-0.60] vs HR, 0.55 [95% CI, 0.50-0.60]; P = .66) among patients without (continued) Key Points Question Is direct-acting antiviral ther...

Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study

“…Few studies have assessed the effect of DAAs compared to notreatment and SVR compared to no-SVR on all-cause and liverrelated mortality. 17,18,[29][30][31] Design and comparison groups differ across studies. Our findings on the impact of SVR from DAAs on all-cause and liver-related mortality are consistent with some studies, while a relatively lower reduction was reported in other studies.…”

“…18 Similar findings of lower all-cause mortality reduction have been reported from Medicare beneficiaries from the US (without cirrhosis aHR 0.51; 95% CI 0.46-0.57). 31 None of these studies assessed the impact of treatment and SVR on drug-related mortality, which is a critical issue among people with HCV in Canada, the US and many other countries. [10][11][12] Overall, our findings indicate a significant impact of DAAs on mortality.…”

Association of the Extension for Community Healthcare Outcomes Project With Use of Direct-Acting Antiviral Treatment Among US Adults With Hepatitis C

“…2 Recently developed secondgeneration direct-acting antiviral (DAA) drugs have cure rates greater than 90%, which is higher than the 50% cure rate with former interferon-based treatments. 3 In addition, DAAs are easy to administer (1 pill per day), require a short treatment period (8-12 weeks), and have few adverse effects. Direct-acting antiviral therapy is associated with a 49% to 68% reduction in HCV all-cause mortality.…”

“…Direct-acting antiviral therapy is associated with a 49% to 68% reduction in HCV all-cause mortality. 3,4 The availability of DAAs has therefore given hope that HCV infection can be eliminated. 5 The World Health Organization has set a goal of reducing the incidence of HCV infection by 80% by 2030 and has recommended treating all adults with chronic HCV infection with DAAs.…”

Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies

“…These two medications had limited efficacy and numerous side effects; a systematic review and meta-analysis estimated that only 25% of patients with chronic HCV infection were treated with these therapies [ 9 ]. The cure rate associated with DAAs is approximately 98% [ 10 ], which is much higher than the 50% cure rate associated with interferon-based therapy [ 11 ]. Now that the potency of HCV treatment has improved, the focus has shifted to expanding access to treatment and decreasing HCV-associated morbidity and mortality.…”