Monitoring the hepatitis C care cascade using administrative claims data

Abstract

Objectives: With the availability of curative therapies, it is important to ensure that individuals infected with hepatitis C virus (HCV) receive recommended testing, care, and treatment. We sought to evaluate insurance claims data as a source for monitoring progression along the HCV care cascade.

Study design: Longitudinal evaluation of disease progression, from diagnosis to treatment, among commercially insured enrollees with chronic HCV.

Methods: We validated and used algorithms derived from standardized procedure and diagnosis codes to identify enrollees with chronic HCV in large insurance claims databases to describe the HCV care cascade, including the proportion engaged in HCV-specific care (13 possible definitions), the proportion prescribed HCV treatment, and the proportion who received an HCV RNA test 30 or more days after initiating treatment.

Results: Approximately 90% of individuals with an HCV RNA test procedure code followed by either 3 or more chronic HCV diagnosis codes on different service dates or 2 or more chronic HCV diagnosis codes separated by more than 60 days truly had chronic HCV. Using these algorithms, we identified 5791 HCV cases from January 1, 2013, to June 30, 2014. Among enrollees with HCV, 95% were engaged in HCV care, but only 49% initiated treatment and 43% received a follow-up HCV RNA test 30 or more days after initiating treatment.

Conclusions: With validated case-finding algorithms, insurance claims data can be used to describe and monitor portions of the HCV care cascade. Although nearly all enrollees with HCV were engaged in HCV care, only half received treatment, indicating that even commercially insured enrollees may find it challenging to access treatment.

FIGURE 1.. Study Group Selection for HCV

CPT indicates Current Procedural Terminology; HCV, hepatitis C virus.

FIGURE 2.. Care Cascade Among Enrollees Living With HCV in MarketScan Commercial and Medicare Supplemental Insurance Claims Data, 2013-2014

CPT indicates Current Procedural Terminology; DAA, direct-acting antiviral; HCV, hepatitis C virus; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification. ^aEnrollees identified with chronic HCV infection by validated algorithms applied to insurance claims data: HCV RNA CPT code followed by 2 or more chronic HCV ICD-9-CM diagnosis codes separated by more than 60 days (algorithm 7), or HCV RNA CPT code followed by 3 or more chronic HCV ICD-9-CM codes on different service dates (algorithm 9). ^bEnrollees meeting at least 1 of 13 different definitions of engagement in care (Table 2). ^cEnrollees who filled prescriptions for HCV treatment. DAA indicates enrollees who were ever prescribed DAA drugs as part of their HCV treatment regimen. Those not prescribed DAAs were treated only with interferon-based regimens. ^dEnrollees with HCV RNA CPT code 30 or more days after initiating HCV treatment.