Background: Hepatitis C virus infection causes liver fibrosis and ultimately cirrhosis. There are several noninvasive methods to assess fibrosis. The gold standard is a liver biopsy. The degree of liver fibrosis can be staged from 0-4 using the Metavir scoring system. The introduction of direct acting agents to treat this infection has improved cure rates to almost 99%. This study undertaken in a clinic setting aimed to find proportions of patients in treated for hepatitis C clinic with the different stages of fibrosis and genotypes; as well as quantify the impact of a state Medicaid program intended to limit treatment to patients with Metavir Score >3.
Methods: This retrospective study spanned a four-year period through April of 2016. It involved a review of patient records to derive age, gender, genotype, Metavir fibrosis score, complete blood count and complete metabolic panel prior to treatment.
Results: 183 patient records were reviewed. 127(69.3%) had a complete work up done and met criteria for inclusion. 56 of the patients were excluded from analysis because of inpatient status or lack of follow up which prevented the evaluation needed for treatment. The male: female ratio was 1.77:1. Genotype distributions were as follows: genotype 1: 69 +/- 9.66%; genotype 3: 19.69 +/- 6.91%, genotype 2: 8.66% +/- 4.89%, all at a 95% confidence intervals (CI). Median age was 57 with a range of 23- 74. Metavir score of 2 was the most common (36.13 +/-8.62%), followed by stage 1 (26.89 +/- 7.96%), and stage 4 (17.65+/-6.84%) at 95% CI. 27 out of 52 Medicaid funded completed evaluation for treatment. 20 (74%) were denied treatment because they had a Metavir score of <3. The probability that a Medicaid patient who presented for treatment will be denied was 74 +/- 16.5% at 95% CI.
Conclusion: Medicaid patients with a Metavir score of <3 are 74 times more likely to be denied treatment compared with patients with other insurance. The policy needs to change to be more inclusive. 68.91 % of patients included in the study had a fibrosis score of < 3.Twice as many men compared to women presented for treatment. Women should be targeted for testing and treatment. Older people seek and pursue treatment. Young people are less likely to follow through with evaluation and treatment.
B. Ayi, None