Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 2;9(9):ofac445.
doi: 10.1093/ofid/ofac445. eCollection 2022 Sep.

The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially Insured Population

Nicole D Ferrante  1   2 , Craig W Newcomb  2 , Kimberly A Forde  3 , Charles E Leonard  2   4 , Jessie Torgersen  2   5 , Benjamin P Linas  6 , Sarah E Rowan  7 , David L Wyles  7 , Jay Kostman  8 , Stacey B Trooskin  5   8 , Vincent Lo Re 3rd  2   5
Affiliations

The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially Insured Population

Nicole D Ferrante et al. Open Forum Infect Dis. .

Abstract

Background: Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States.

Methods: We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure.

Results: Among 120,311 individuals estimated to have HCV viremia in Optum during the study period, 109,233 (90.8%; 95% CI, 90.6%-91.0%) had a recorded diagnosis of HCV infection, 75,549 (62.8%; 95% CI, 62.5%-63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41,102 (34.2%; 95% CI, 33.9%-34.4%) were dispensed DAA treatment, and 25,760 (21.4%; 95% CI, 21.2%-21.6%) were assessed for cure.

Conclusions: Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals.

Keywords: HIV/HCV coinfection; cascade of care; health claims database; hepatitis C elimination; hepatitis C monitoring.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Selection of eligible health plan members within the Optum de-identified Clinformatics® Data Mart Database between January 1, 2014 and December 31, 2019.
Figure 2.
Figure 2.
Hepatitis C care cascade within the Optum de-identified Clinformatics® Data Mart Database between January 1, 2014 and December 31, 2019. The proportion dispensed direct-acting antiviral therapy and assessed for sustained virologic response was determined through May 31, 2020. Bars indicate 95% CI. Abbreviations: DAA, direct-acting antiviral; HCV, hepatitis C virus; SVR12, sustained virologic response ≥12 weeks after completing therapy.
Figure 3.
Figure 3.
Hepatitis C care cascade for people with HIV coinfection within the Optum de-identified Clinformatics® Data Mart Database between January 1, 2014 and December 31, 2019. The proportion dispensed direct-acting antiviral therapy and assessed for sustained virologic response was determined through May 31, 2020. Bars indicate 95% CI. Abbreviations: DAA, direct-acting antiviral; HCV, hepatitis C virus; SVR12, sustained virologic response ≥12 weeks after completing therapy.
See this image and copyright information in PMC

References

    1. Rosenberg ES, Rosenthal EM, Hall EW, et al. Prevalence of hepatitis C virus infection in US states and the District of Columbia, 2013 to 2016. JAMA Netw Open 2018; 1:e186371. - PMC - PubMed
    1. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013–2016. Hepatology 2019; 69:1020–31. - PMC - PubMed
    1. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol 2014; 61(1 Suppl):S58–68. - PubMed
    1. Backus LI, Boothroyd DB, Phillips BR, et al. A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol 2011; 9:509–16.e1. - PubMed
    1. Carrat F, Fontaine H, Dorival C, et al. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet Lond Engl 2019; 393:1453–64. - PubMed