The use of all-oral direct-acting antivirals in hepatitis C virus-infected patients with substance use disorders

Jiang, Xinyi; Song, Hyun Jin; Wang, Wei; Henry, Linda; Childs‐Kean, Lindsey M.; Re, Vincent Lo; Park, Haesuk

doi:10.18553/jmcp.2021.27.7.873

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…The odds of being treated for HCV among those with an SUD or mental illness did not improve from the pre-DAA to post-DAA period, although DAAs have no contraindications with SUD or mental illness. Our findings collaborate with previous studies comparing DAA treatment uptake among Florida Medicaid beneficiaries with SUD and commercially insured patients 12,19. Medicaid’s restriction/rigid prior authorization criteria for DAA prescribing (ie, 3-month sobriety from drug and/or alcohol use) may lead to a low treatment initiation rate in these populations 12.…”

Section: Discussionsupporting

confidence: 88%

“…Our findings collaborate with previous studies comparing DAA treatment uptake among Florida Medicaid beneficiaries with SUD and commercially insured patients. 12,19 Medicaid's restriction/rigid prior authorization criteria for DAA prescribing (ie, 3-month sobriety from drug and/or alcohol use) may lead to a low treatment initiation rate in these populations. 12 Other multifaceted issues may include patients' refusals and physicians' concerns.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Access to Hepatitis C Treatment Among Arizona Medicaid Beneficiaries With Chronic Hepatitis C

Jiang¹,

Song²,

Chang³

et al. 2022

Medical Care

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Background: High costs of direct-acting antivirals (DAAs) have led to their restricted access for patients with hepatitis C virus (HCV).Objective: The aim was to assess how HCV treatment access and predictors of HCV treatment changed in the post-DAA period compared with pre-DAA period.Methods: A retrospective cohort study using Arizona Medicaid data was conducted for patients with HCV to compare treatment initiation rates between pre-DAA (January 2008-October 2013) and post-DAA (November 2013-December 2018) periods. Multivariable logistic regression was used, controlling for demographic and clinical variables.Results: Twenty-four thousand and ninety and 28,756 patients during the pre-DAA and post-DAA periods were identified. Overall, 12.6% were treated in the post-DAA period compared with 7.8% in the pre-DAA period (P < 0.001). The relative increase in the HCV treatment initiation rate from the pre-DAA to the post-DAA period was significant greater for Black beneficiaries compared with White beneficiaries (P = 0.002). Hispanic beneficiaries were less likely to be treated in the post-DAA period [adjusted odds ratios (aOR): 0.88; CI: 0.79-0.98] compared with White beneficiaries. Those with mental illness (aOR: 0.71; 95% CI: 0.63-0.80) and substance use disorders (aOR: 0.63; 95% CI: 0.58-0.68) were less likely to be treated in the post-DAA period.Conclusions: Although treatment initiation increased and disparities for Black beneficiaries compared with White beneficiaries attenuated in the post-DAA period, only 13% of Arizona Medicaid patients with HCV received DAA treatment. Disparities in DAA access remained among Hispanic patients and those with mental illness and substance use disorders.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Disparities in Access to Hepatitis C Treatment Among Arizona Medicaid Beneficiaries With Chronic Hepatitis C

Jiang¹,

Song²,

Chang³

et al. 2022

Medical Care

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“…Given the demonstrated efficacy of DAA treatment, work has been done to identify barriers to care in the PWID population in pursuit of equitable and effective treatment outcomes. Between 2012 and 2018, DAA initiation measurements in a population of 29 228 newly infected HCV patients found a 24% therapy initiation rate among those with a substance use disorder, compared to a 34% rate for those without [38]. Factors believed to be driving this disparity include a lack of care integration among mental and physical health providers, discriminatory drug and alcohol abstinence requirements for publicly funded state programs, prior authorization requirements, provider bias, and lack of patient symptoms all being proposed as impeding access [35,39,40].…”

Section: Discussionmentioning

confidence: 99%

The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019

Lee

Ponder

Lee

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Background and aims Hepatitis C virus (HCV) is a prominent liver disease that often presents with mental illness. We stratify the HCV population and review its healthcare burden on the US hospital system. Methods The US National Inpatient Sample was used to select admissions related to HCV between 2016 and 2019. Weights were assigned to discharges, and trend analyses were performed. Strata were formed across demographics, comorbidities, psychiatric and substance use conditions, and other variables. Outcomes of interest included hospitalization incidences, mortality rates, total costs, and mean per-hospitalization costs. Results From 2016 to 2019, there were improvements in mortality and hospitalization incidence for HCV, as well as a decline in aggregate costs across the majority of strata. Exceptions that showed cost growth included admissions with multiple psychiatric, stimulant use, or poly-substance use disorders, and a history of homelessness. Admissions with no psychiatric comorbidities, admissions with no substance use comorbidities, and admissions with housing and without HIV comorbidity showed decreasing total costs. Along with per-capita mean costs, admissions with comorbid opioid use, bipolar, or anxiety disorder showed significant increases. No significant trends in per-capita costs were found in admissions without mental illness diagnoses. Conclusions Most strata demonstrated decreases in hospitalization incidences and total costs surrounding HCV; however, HCV cases with mental illness diagnoses saw expenditure growth. Cost-saving mechanisms for these subgroups are warranted.

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“…DAA therapy is available to patients with HCV infection at no or substantially reduced cost to the individual in the VA system . Despite these recommendations, some clinicians continue to delay or withhold HCV therapy from patients who consume alcohol . Furthermore, some payers include alcohol abstinence as a requirement for reimbursement of DAA therapy for HCV .…”

Section: Introductionmentioning

confidence: 99%

Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy

Cartwright,

Pierret,

Minassian

et al. 2023

JAMA Netw Open

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ImportanceSome payers and clinicians require alcohol abstinence to receive direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection.ObjectiveTo evaluate whether alcohol use at DAA treatment initiation is associated with decreased likelihood of sustained virologic response (SVR).Design, Setting, and ParticipantsThis retrospective cohort study used electronic health records from the US Department of Veterans Affairs (VA), the largest integrated national health care system that provides unrestricted access to HCV treatment. Participants included all patients born between 1945 and 1965 who were dispensed DAA therapy between January 1, 2014, and June 30, 2018. Data analysis was completed in November 2020 with updated sensitivity analyses performed in 2023.ExposureAlcohol use categories were generated using responses to the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses for alcohol use disorder (AUD): abstinent without history of AUD, abstinent with history of AUD, lower-risk consumption, moderate-risk consumption, and high-risk consumption or AUD.Main Outcomes and MeasuresThe primary outcome was SVR, which was defined as undetectable HCV RNA for 12 weeks or longer after completion of DAA therapy. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% CIs of SVR associated with alcohol category.ResultsAmong 69 229 patients who initiated DAA therapy (mean [SD] age, 62.6 [4.5] years; 67 150 men [97.0%]; 34 655 non-Hispanic White individuals [50.1%]; 28 094 non-Hispanic Black individuals [40.6%]; 58 477 individuals [84.5%] with HCV genotype 1), 65 355 (94.4%) achieved SVR. A total of 32 290 individuals (46.6%) were abstinent without AUD, 9192 (13.3%) were abstinent with AUD, 13 415 (19.4%) had lower-risk consumption, 3117 (4.5%) had moderate-risk consumption, and 11 215 (16.2%) had high-risk consumption or AUD. After adjustment for potential confounding variables, there was no difference in SVR across alcohol use categories, even for patients with high-risk consumption or AUD (OR, 0.95; 95% CI, 0.85-1.07). There was no evidence of interaction by stage of hepatic fibrosis measured by fibrosis-4 score (P for interaction = .30).Conclusions and RelevanceIn this cohort study, alcohol use and AUD were not associated with lower odds of SVR. Restricting access to DAA therapy according to alcohol use creates an unnecessary barrier to patients and challenges HCV elimination goals.

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The use of all-oral direct-acting antivirals in hepatitis C virus-infected patients with substance use disorders

Cited by 6 publications

References 31 publications

Disparities in Access to Hepatitis C Treatment Among Arizona Medicaid Beneficiaries With Chronic Hepatitis C

Disparities in Access to Hepatitis C Treatment Among Arizona Medicaid Beneficiaries With Chronic Hepatitis C

The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019

Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy

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