Fewer Hepatitis C Patients Seeking Treatment of Late

The number of people with hepatitis C virus (HCV) treated with direct-acting antiviral agents (DAAs) dropped sharply in 2020, accelerating a decline that began in 2015, CDC researchers found.

While 843,362 individuals from 2014-2020 were estimated to receive DAAs for HCV, only 83,740 initiated DAA treatment in 2020, down from 114,893 in 2019 and a high of 164,247 in 2015, reported Eyasu Teshale, MD, of the CDC, and colleagues.

On average, 120,000 patients with HCV were given DAA treatment annually from 2014 to 2020, which is significantly fewer than the goal set by the National Academies of Science, Engineering, and Medicine that requires at least 260,000 HCV patients to be treated annually in order to achieve HCV elimination by 2030.

These data were released ahead of their planned presentation at the American Association for the Study of Liver Diseases (AASLD) virtual annual meeting.

"We know COVID-19-related disruptions to hepatitis C testing and treatment likely contributed to the low treatment numbers in 2020, but seeing this number next to the previous annual trends underscores the magnitude of the pandemic's impact on treating hepatitis C in the United States," Teshale told MedPage Today. "While the study doesn't tell us why treatment peaked in 2015, it's likely related to many people with hepatitis C waiting to be treated with DAAs as soon as they became available beginning in 2013."

"This research is critical as it allows us to track progress towards HCV elimination goals," said Risha Renee Irvin, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, who was not involved in this study. "Direct-acting antiviral agents have undoubtedly expanded access to treatment but this data highlights the additional work that must be done to reach HCV elimination metrics."

Daniel Raymond, BA, of the National Viral Hepatitis Roundtable (NVHR) in Washington D.C., called these data "concerning and disappointing" in a statement.

"In spite of dramatic declines in the cost of these medications, at the current rate of treatment, we are estimated to fall significantly short of our goal to eliminate viral hepatitis by 2030," he said.

Teshale and colleagues evaluated IMS Health & Quintiles (IQVIA) data from 2014 to 2020 on 843,362 individuals with HCV who had evidence of receiving DAAs. They were stratified based on insurance status, age group, sex, race, type of DAA, and treatment year.

Overall, 60% of the individuals were men, and almost two-thirds were "baby boomers." The authors noted that race/ethnicity data was missing for two-thirds of the cohort, but of those with data available, 68% of individuals were white. Sixty percent of prescribers were specialists. The two most commonly prescribed DAA regimens were sofosbuvir/velpatasvir (Epclusa) in 46% and glecaprevir/pibrentasvir (Mavyret) in 44%.

Interestingly, the annual proportion of DAAs dispensed to baby boomers declined sharply from 2014 to 2020 (74% vs 46.3%, respectively), with a corresponding increase among those born after 1965 (17% vs 51%).

Likewise, the proportion of Medicare-paid claims declined from 30% to 25% during the study period, but the proportion of Medicaid-paid claims increased from 7% to 15%.

Raymond called for confronting "the root causes of barriers to treatment" for the most vulnerable populations, including "removing policy restrictions that prevent people from accessing hepatitis C treatments in state Medicaid programs, implementing and financing proven care coordination and patient navigation models, and reaching the most vulnerable populations with testing and linkage to care," he added.

"Additionally, I agree that the removal of any restrictions on receipt of HCV treatment based on provider status, liver fibrosis, and substance use history should be prioritized," said Irvin.

The analysis had several limitations, researchers acknowledged, including the absence of demographic information for a large proportion of the cohort. Data also only came from one source, a longitudinal prescription claims database, which excludes data from the Veteran's Affairs health system and long-term care pharmacies.

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