Racial/Ethnic and Socioeconomic Disparities in Use of Direct-Acting Antivirals Among Medicare Beneficiaries with Chronic Hepatitis C, 2014-2016

Abstract

BACKGROUND: New hepatitis C virus (HCV) drugs – direct acting antivirals (DAAs) – are highly effective but costly. This raises a concern about limited access to DAAs by vulnerable populations. Prior studies of disparities in DAA use across patient groups showed mixed results, but their generalizability was limited due to using data from a commercial insurer(s) or from 2014 only – the first year of DAAs. Disparities in DAA use in a national cohort in the years when more DAAs were available is unknown. OBJECTIVE: To examine whether disparities in DAA use by patient race/ethnicity and socio-economic status (SES) in Medicare changed between 2014 and 2016. METHODS: The study population was chronic hepatitis C patients in Fee-For-Service Medicare with Part D between 2014 and 2016. We used multinomial logistic regression to estimate adjusted odds ratios (aOR) of using DAAs by patient race/ethnicity and SES. We estimated the model separately for 2014 and 2014–2016. RESULTS: Of 281,810 Medicare patients who were followed to the end of 2016, 90,419 (32.1%) filled prescriptions for DAAs. In the 2014 analysis, blacks were less likely to use DAAs than whites (aOR=0.95; 95% CI=0.91–0.99). However, in the analysis of 2014–2016, blacks had higher odds of using DAAs than whites (aOR=1.24; 95% CI=1.22–1.27). No significant Hispanic-white gap existed during the study period. Income was positively associated with DAA use in both periods. Between 2014 and 2016, patients who received a Part D low-income subsidy had lower odds of using DAAs than patients who did not (aOR=0.90; 95% CI=0.88–0.92), and patients in areas with the higher income tertiles were more likely to initiate DAAs than those in areas with the lowest income tertile. CONCLUSIONS: DAA use among Medicare patients remained far below the level needed to eradicate HCV. The black-white gap in HCV treatment was closed by 2016, but disparities by patient SES remained. DAA use also varied by patient age and health risk, as well as across geographic regions. Continued efforts to improve DAA uptake in all HCV patients are needed to accomplish the goal of HCV eradication.

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

“…The situation is less clear with our Medicare respondents, although there have been reports of difficulties with receipt of DAAs among Medicare recipients, particularly those lacking Part D coverage or with Part D coverage subject to high copays, or with Medicare/Medicaid dual coverage subject to state‐specific Medicaid drug coverage rules. ( 48 ) Unfortunately, not all our study sites (each in a different state) collected information on Part D coverage, so we were not able to discern whether or to what degree this might be an issue.…”

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

“…This finding is consistent with those of previous studies of Medicare populations with HCV infection. 8,12,30 A major reason for low DAA uptake is the insufficient numbers of physicians with experience in cases of HCV infection, especially in rural and underserved areas. 12 However, with task-shifting treatment models such as…”

Delays and gaps in progressing through the hepatitis C virus cascade of care: An underserved safety-net hospital experience

“…[13][14][15] For example, Jung et al evaluated 281,810 Medicare patients with chronic HCV and observed significantly higher odds of HCV therapy in African Americans compared to non-Hispanic whites (adjusted OR 1.24, 95% CI 1.22-1.27), but no significant differences in Hispanics. [15] However, Spradling et al evaluated the Chronic Hepatitis Cohort Study from 2014-2015 and observed 30% lower odds of treatment in African Americans compared to non-Hispanic whites; Wong et al evaluated 29,544 chronic HCV patients across four community-based healthcare systems and observed significantly lower odds of HCV treatment in Hispanics compared to non-Hispanic whites (adjusted odds ratio 0.48, 95% CI 0.39-0.60). [8,14] We aim to evaluate the overall rates of HCV linkage to care (LTC), retention to care, and access to treatment in an ethnically diverse safety-net population with a specific focus on sex-specific and race/ ethnicity-specific disparities.…”

“…Existing studies have reported on race/ethnicity-specific disparities in access to HCV treatment. [ 13 , 14 , 15 ] For example, Jung et al . evaluated 281,810 Medicare patients with chronic HCV and observed significantly higher odds of HCV therapy in African Americans compared to non-Hispanic whites (adjusted OR 1.24, 95% CI 1.22–1.27), but no significant differences in Hispanics.…”

“…evaluated 281,810 Medicare patients with chronic HCV and observed significantly higher odds of HCV therapy in African Americans compared to non-Hispanic whites (adjusted OR 1.24, 95% CI 1.22–1.27), but no significant differences in Hispanics. [ 15 ] However, Spradling et al . evaluated the Chronic Hepatitis Cohort Study from 2014–2015 and observed 30% lower odds of treatment in African Americans compared to non-Hispanic whites; Wong et al .…”