BACKGROUND & AIMS:
BACKGROUND:Hepatitis C virus (HCV) treatment regimens (DAAs) are well tolerated, efficacious but costly. Their high cost and restricted availability, raises concerns about the outcome of treatment in uninsured patients. This study investigated sustained virologic response (SVR) outcomes in a predominately uninsured patient population and completion of four steps along the HCV treatment cascade.
METHODS:A retrospective chart review was conducted to characterize the patient population and analyze covariates to determine association with insurance status, attainment of SVR and progression through the HCV treatment cascade.
RESULTS:Out of a total of 216 patients, 154 (71%) were uninsured. Approximately 50% of patients (109 of 216 patients) were male and 57% were Hispanic (123 of 216 patients). Sex, race, ethnicity, treatment compliance, and rates of complications were not associated with insurance status. Insured patients were older (median 60 years vs 57 years, p-value < 0.001) and had higher rates of cirrhosis: 32 out of 62 patients (52%) vs 48 out of 154 patients (31%) (p-value = 0.005). Insured patients were tested for SVR at similar rates as uninsured patients: 84% (52 of 62 patients) vs 81% (125 of 154 patients), respectively. Of those tested for SVR, the cure rate for insured patients was 98% (51 out of 52 patients) compared to 97% (121 out of 125 patients) in the uninsured. Out of those who completed treatment, 177 of 189 (94%) were tested for attainment of SVR. Compliance rates were significantly different between tested and untested patients: 88% (156 of 177 patients) vs 0% (0 of 12 patients), respectively (p-value < 0.001). However, insurance status, race ethnicity, cirrhosis, and complications were not associated with being tested for SVR.
CONCLUSIONS:These results demonstrate that insured and uninsured patients with chronic HCV infection, with access to patient assistance programs, can be treated and have comparable clinical outcomes. In addition, testing for SVR remains an important obstacle in completion of the HCV treatment cascade. Nevertheless, patient assistance programs remove a significant barrier for treatment access in real-world HCV infected populations.
背景与目标:
背景:丙型肝炎病毒(HCV)治疗方案(DAA)具有良好的耐受性,有效但昂贵。它们的高成本和有限的可获得性引起了对未投保患者的治疗结果的担忧。这项研究调查了在未保险人群中持续的病毒学应答(SVR)结果,以及沿着HCV治疗级联反应完成的四个步骤。
方法:进行回顾性图表审查以表征患者人群并分析协变量,以确定与保险状况,SVR的获得程度以及通过HCV治疗级联的进展之间的关联。
结果:在总共216位患者中,有154位(71%)未投保。大约50%的患者(216名患者中的109名)是男性,而57%是西班牙裔(216名患者中的123名)。性别,种族,种族,治疗依从性和并发症发生率与保险状况无关。受保患者年龄较大(中位年龄为60岁vs 57岁,p值<< 0.001)并且肝硬化发生率更高:62位患者中的32位(52%)与154位患者中的48位(31%)(p值= 0.005 )。受保患者接受SVR的检出率与未受保患者相似:分别为84%(62名患者中的52名)和81%(154名患者中的125名)。在接受SVR测试的患者中,参保患者的治愈率为98%(52例中的51例),而未参保患者的治愈率为97%(125例中的121例)。在完成治疗的患者中,有189名中的177名(94%)接受了SVR的检测。在接受测试和未经测试的患者中,依从率显着不同:分别为88%(177名患者中的156名患者)和0%(12名患者中的0名)(p值<0.001)。但是,保险身份,种族,肝硬化和并发症与接受SVR测试无关。
结论:这些结果表明,患有慢性HCV感染的被保险人和非被保险人,只要获得患者援助计划,就可以得到治疗,并具有可比的临床结果。此外,对SVR的测试仍然是完成HCV治疗级联的重要障碍。尽管如此,患者援助计划消除了在现实世界中被HCV感染人群获得治疗的重大障碍。