Racial Differences in the Evaluation and Treatment of Hepatitis C Among Veterans: A Retrospective Cohort Study

Background The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for complex health problems such as hepatitis C virus (HCV) infection for underserved populations. Using videoconferencing technology, ECHO trains primary care providers to treat complex diseases. Methods A prospective cohort study compared treatment of HCV at the University of New Mexico (UNM) HCV clinic to treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 treatment naive patients with chronic HCV were enrolled. The primary end point was a sustained viral response (SVR). Results The rate of SVR was 57.5% (84/146) for patients treated at UNM and 58.2% (152 /261) at ECHO sites (P=0.89); difference between SVR rates 0.7% (95% CI -9.2%, 10.7%). In genotype 1 infection the SVR rate was 45.8% (38 /83) at UNM and 49.7% (73 /147) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the UNM HCV clinic cohort and 6.9% of the ECHO cohort. Conclusions This study demonstrates that the ECHO model is an effective way to treat HCV in underserved communities. Implementation of this model would allow other states and nations to treat more patients with HCV.

show abstract

“…12 Members of racial and ethnic minorities and older patients are less likely to receive needed care. 13,14,15,16 …”

Section: Introductionmentioning

confidence: 99%

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Another possible explanation is that payers use prior authorization for new HCV drugs due to the high prices of the drugs [17, 18, 27]. These tools—such as requiring that the drug be prescribed by a specialist and having control of HIV viral load when coinfected with HIV—may have disproportionally affected Black patients, who may be less engaged with the health care system [28]. Although restrictive coverage for new HCV drugs has been an ongoing concern, its potential impacts on disparities in uptake of the new drugs have not been assessed.…”

Section: Discussionmentioning

confidence: 99%

Racial-Ethnic Disparities in Uptake of New Hepatitis C Drugs in Medicare

Jung

Feldman

2016

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

Background Chronic hepatitis C is an important public health concern. Recently launched drugs to treat hepatitis C virus (HCV) infection are effective but costly. Uptake of innovative and expensive prescription drugs may not be even across patient groups. We examined racial-ethnic disparities in uptake of new HCV drugs in the first year of their use (year 2014) in Medicare. Methods The study population was Medicare beneficiaries who had chronic hepatitis C in 2013 or 2014 and who were continuously enrolled in Part D stand-alone Prescription Drug Plans in 2014. We examined trends in monthly uptake of new HCV drugs and adjusted annual uptake rates by race. We used logistic regressions to obtain adjusted odds ratios and adjusted differences in annual uptake rates. Results Monthly uptake of new HCV drugs was lower among Black Medicare patients than Whites or Hispanics in 2014. The racial gap in monthly uptake became narrower toward the end of the year. Adjusted odds of using new HCV drugs were 11% lower for Blacks with cirrhosis than Whites (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.84–0.95), and 16% lower for Blacks with HCV/HIV coinfection than Whites (OR = 0.81; 95% CI, 0.72–0.92). Annual uptake rates were not significantly different for Whites and Hispanics. Conclusions Black Medicare patients with cirrhosis or HCV/HIV coinfection had lower uptake rates than Whites in 2014. As utilization of new HCV drugs increases, continuing efforts will be necessary to ensure equal delivery of the drugs.

show abstract

“…6 Comorbid medical illness, lack of insurance, psychiatric illness, and active substance abuse have been identified as common barriers to initiation of treatment. [7][8][9] We hypothesize that individuals with treatment barriers of this type may not be medically equivalent to, and may have a worse prognosis than, treatment-eligible control or unsuccessfully treated patients in published studies proving the benefits of SVR in persons who had hepatitis C.…”

mentioning

confidence: 99%

Limited Fibrosis Progression but Significant Mortality in Patients Ineligible for Interferon-Based Hepatitis C Therapy

Izzy

Jibara

Aljanabi

et al. 2016

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Background: Individuals ineligible for interferon-based hepatitis C therapy may have a worse prognosis than patients who have failed or not received treatment. Aims: To provide information about the limitations of medical treatment of hepatitis C in real-world patients. Methods: We studied 969 treatment-ineligible patients and 403 treated patients enrolled between 1/1/01 and 6/30/06; data were collected until 3/31/13. Treatment barriers were grouped into five categories and classified as health-related or health-unrelated. Fibrosis stage was assessed initially and at the end of follow-up. Mortality was determined by search of the Social Security database. Death certificates of treatment-ineligible patients were reviewed. Results: Initially, 288 individuals had advanced fibrosis and compensated disease; 87 untreated patients developed advanced fibrosis during follow-up. Health-related treatment barriers were more commonly associated with fibrosis progression and worse survival. During followup, 247 untreated patients died: 47% of liver-related and 53% of liver-unrelated causes. Patients with significant comorbid illness had the worst five-year (70%) and ten-year (50.5%) survival. Despite high mortality (47%) in persons with decompensated liver disease, no treatment barrier was associated with a greater incidence of liverrelated death. Only significant comorbid medical illness was an independent predictor of disease progression; however, it was not associated with a greater incidence of liver-related death. Furthermore, treated patients had better 10-year survival than untreated patients on Kaplan-Meier analysis (80.3% vs. 74.5%, P = 0.005). Conclusion: Many patients with hepatitis C will die of non-liver-related causes and may not be helped by anti-viral treatment. ( J CLIN EXP HEPATOL 2016;6:100-108)

show abstract

Racial Differences in the Evaluation and Treatment of Hepatitis C Among Veterans: A Retrospective Cohort Study

Abstract: Race is associated with receipt of medical care for various medical conditions. Further investigation is warranted to help understand whether patient preference or provider bias may explain why HCV-infected Blacks were less likely to receive medical care than Whites.

Cited by 36 publications

References 50 publications

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Racial-Ethnic Disparities in Uptake of New Hepatitis C Drugs in Medicare

Limited Fibrosis Progression but Significant Mortality in Patients Ineligible for Interferon-Based Hepatitis C Therapy

Contact Info

Product

Resources

About