524. Racial/Ethnic and Socioeconomic Disparities in Initiation of Direct-Acting Antiviral Agents for Hepatitis C Virus in an Insured Population
Session: Poster Abstract Session: Hepatitis B and C in Varied Settings
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Marcus IDWeek HCV poster FINAL.pdf (447.5 kB)
  • Background: The high cost of direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) infection may present a barrier to access, thus contributing to disparities in treatment. However, few real-world data exist on factors associated with DAA uptake.

    Methods: We conducted an observational study of Kaiser Permanente Northern California members with HCV infection, defined as a positive HCV RNA test or an HCV genotype, during the recent DAA era (i.e., October 2014–December 2016). To evaluate factors independently associated with DAA initiation, an adjusted Poisson model included age, sex, race/ethnicity, census-based neighborhood deprivation index, HCV genotype, advanced fibrosis (i.e., Fibroscan ≥9.5 kPa, if available; else FIB-4 >3.25), prior HCV treatment, drug abuse diagnosis, smoking, alcoholic drinks per week, HIV infection, and hepatitis B virus infection.

    Results: We identified 18,140 HCV-infected individuals, of whom 6167 (34%) initiated DAA treatment. Treatment was less likely among Black (risk ratio [RR] 0.83, 95% confidence interval [CI]: 0.79-0.88) and Hispanic individuals (RR 0.92, 95% CI: 0.87-0.98) compared with White individuals, and among individuals with greater neighborhood-level economic disadvantage (quartile 3 vs. 1: RR 0.89, 95% CI: 0.85-0.94; quartile 4 vs. 1: RR 0.79, 95% CI: 0.75-0.83). Treatment was also less likely among those with a history of drug abuse (RR 0.87, 95% CI: 0.82-0.91), smoking (RR 0.84, 95% CI: 0.80-0.87), or more alcoholic drinks per week (1-7 vs. 0 drinks: RR 0.88, 95% CI: 0.82-0.93; 8-16 vs. 0 drinks: RR 0.72, 0.63-0.82); ≥17 vs. 0 drinks: RR 0.63, 95% CI: 0.49-0.80). There was a higher likelihood of treatment among individuals with advanced fibrosis (RR 1.39, 95% CI: 1.34-1.44), HCV genotype 1 (RR 1.97, 95% CI: 1.87-2.08), no prior HCV treatment (RR 1.44, 95% CI: 1.37-1.52), or HIV infection (RR 1.19, 95% CI: 1.08-1.30).

    Conclusion: Although clinical factors appear to drive HCV treatment decisions, racial/ethnic and socioeconomic disparities exist in DAA uptake. Lifestyle factors, such as alcohol use and drug abuse, may also influence patient or provider decision-making regarding DAA initiation. Strategies are needed to ensure equitable access to DAAs, even in insured populations.

    Julia Marcus, PhD, MPH1, Leo Hurley, MPH2, Scott Chamberland, PharmD3, Jamila Champsi, MD4, Laura Gittleman, RN, MBA5, Daniel Korn, MD6, Jennifer Lai, MSc, PharmD7, Charles Quesenberry Jr., PhD2, Joanna Ready, MD8, Varun Saxena, MD4, Suk Seo, MD9,10, David Witt, MD7 and Michael Silverberg, PhD, MPH2, (1)Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (2)Kaiser Permanente Division of Research, Oakland, CA, (3)Kaiser Permanente Northern California, Regional Pharmacy, Oakland, CA, (4)Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, (5)Kaiser Permanente Northern California, Medical Group Support Services, Oakland, CA, (6)Kaiser Permanente Oakland Medical Center, Oakland, CA, (7)Kaiser Permanente San Rafael Medical Center, San Rafael, CA, (8)Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, (9)Kaiser Permanente Antioch Medical Center, Antioch, CA, (10)Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA

    Disclosures:

    J. Marcus, None

    L. Hurley, None

    S. Chamberland, None

    J. Champsi, None

    L. Gittleman, None

    D. Korn, None

    J. Lai, None

    C. Quesenberry Jr., None

    J. Ready, None

    V. Saxena, None

    S. Seo, None

    D. Witt, None

    M. Silverberg, None

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