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Abstract Details
Hepatitis C Screening Rates and Care Cascade in a Large US Insured Population, 2010-2016: Gaps to Elimination
Popul Health Manag. 2020 May 11. doi: 10.1089/pop.2019.0237. Online ahead of print.
Josephine Nhu Tran1, Robert J Wong2, Janet S Lee3, Tim Bancroft1, Ami R Buikema1, Jie Ting3, Norah Terrault4
Author information
1Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA.
2Gastroenterology/Hepatology, Alameda Health System-Highland Hospital, Oakland, California, USA.
3Health Economics and Outcomes Research, Gilead Sciences, Inc., Foster City, California, USA.
4Gastroenterology & Hepatology, University of Southern California, Los Angeles, California, USA.
Abstract
Understanding the health care system's ability to move patients through the hepatitis C virus (HCV) care cascade from screening to treatment is essential for HCV elimination. This retrospective study describes real-world HCV screening rates and care cascade steps to identify gaps in care for patients with HCV in the United States. Eligible patients were aged ≥18 years as of the measurement year (calendar year between January 1, 2010-December 31, 2016) and were commercial and Medicare Advantage with Part D members in the Optum Research database with continuous health plan enrollment 5 years prior to and during the measurement year. Incident and prevalent screening rates were calculated for each measurement year. Care cascade steps were analyzed via Kaplan-Meier analysis and logistic regression among patients with a positive HCV ribonucleic acid test. Cohorts were selected based on birth year (pre-1945 birth cohort, 1945-1965 birth cohort, post-1965 birth cohort). Among the 1945-1965 birth cohort, incident and prevalent screening rates increased from 1.6% to 4.7% and 10% to 18%, respectively, from 2010 to 2016. The proportion of patients attaining each independent cascade step within 1 year of screening increased significantly over time for genotype testing (P = 0.0283) and receipt of treatment (P < 0.0001). Median time from screening to treatment decreased from 1627 days (95% CI 1335-1871) in 2010 to 282 days (95% CI 223-498) in 2015. HCV screening and completion of the care cascade has improved for certain patient populations; however, gaps remain, highlighting the urgent need to address barriers to meeting HCV elimination goals.