Building Oregon Data: Short-term Incidence of Sequelae of Chronic Liver Disease in Medicaid Patients Infected with HCV

Background: Although studies suggest that newer regimens for treating Hepatitis C virus (HCV) infection are cost-effective, little is known about the incidence of severe sequelae of HCV infection in Medicaid patients that could impact the magnitude of these estimates. We sought to better understand the burden of mortality and hepatocellular carcinoma (HCC) in Oregon Medicaid patients with HCV infection. 

Methods:We defined a cohort of Oregon residents ≥18 years old with HCV infection enrolled in Medicaid at least one year during 2009-2013. By matching this cohort to state vital records and the state cancer registry, we estimated the incidence of HCV-related death and HCC during the same time period and used a Cox proportional hazards model for each of these outcomes to evaluate the impact of demographic characteristics.

Results: We identified 11,790 patients with HCV infection. The majority of the patients were white (84%), male (46%), and born between 1945 and 1965 (61%). We identified 474 (4.0%) HCV-related deaths and 156 (1.3%) cases of HCC, corresponding to incidence density rates of 29.8 per 1000 person-years (py) (95% Confidence interval [CI]: 22.7,36.9) and 6.3 per 1000 py (95% CI:5.3, 7.2), respectively. For mortality, the Cox proportional hazards model identified the chief risk factors as age and Asian/Pacific Islander race, while female gender and urban residence were protective. For HCC, the significant risk factors were age and gender.

Conclusion: We quantified the burden of HCV-related morbidity and mortality in Oregon. We also found that Asian/Pacific Islander had the highest risk of death among Medicaid patients with HCV in Oregon. Using state-specific estimates for mortality and HCC, researchers can develop more accurate estimates of the potential cost-effectiveness of using newer regimens to treat Oregon Medicaid patients.

Demographic characteristics associated with HCV-related death & Hepatocellular carcinoma  Oregon Medicaid HCV cohort, 2009-2013 (n=11,790)
	Hazard Ratio	p-value	95% CI
DEATH
Age*	1.14	<0.001	1.10, 1.19
Gender
Female	0.51	<0.001	0.42, 0.61
Male	-	-	-
Race
Asian/Pacific Islander	1.66	0.02	1.08, 2.55
Other races combined	0.96	0.79	0.73,1.27
White	-	-	-
Residence
Urban	0.80	0.02	0.66, 0.96
Rural	-	-	-
HEPATOCELLULAR CARCINOMA
Age*	1.28	<0.001	1.19, 1.38
Gender
Female	0.27	<0.001	0.17,0.41
Male	-	-	-
CI, Confidence interval * For every 5 year increase in age