Disparities in Hepatitis C Treatment Uptake Among U.S. Medicaid Enrollees in 2018: Analysis of National Administrative Data

Author: Shashi Kapadia Hao Zhang Christopher Gonzalez Martin Shapiro Bisakha Sen Ricardo Franco Kayla Hutchings Elaine Wethington Andrew Talal Stephane Labossiere Arpan Dharia Audrey Lloyd Andrew Martin Wells Yuhua Bao

Theme: Epidemiology & Public Health Research Year: 2022

Tracking hepatitis C (HCV) elimination requires measuring direct acting antiviral (DAA) treatment
uptake. The U.S. Medicaid program provides healthcare coverage for low-income individuals,
including many people with HCV. We examined factors associated with receipt of DAA in the 6-
months following a new HCV diagnosis.
We used data from the newly available 2017-8 T-MSIS Analytic File, which includes Medicaid claims
from 50 states, Washington DC, and Puerto Rico. We identified individuals aged 18-64 with a new
diagnosis of HCV in 2018, who were continuously enrolled for 12 months before and 6 months after
the new HCV diagnosis. HCV diagnosis was identified by ICD-10 code. We calculated the proportion
receiving a DAA prescription within 6 months of diagnosis and used logistic regression to examine
demographic factors and ICD-10-identified co-morbidities associated with treatment uptake.
Among 79,567 individuals meeting inclusion criteria, mean age was 45y, 51% were male, 56% white,
16% black, and 11% Hispanic. 58% had an injection drug use diagnosis, and 9% had a cirrhosis
diagnosis. 9,497 (12%) received DAA treatment within 6 months of new HCV diagnosis. In
multivariate regression, age in years (OR 1.09, p<0.0001), male sex (OR 1.37, p<0.0001), and cirrhosis
(OR 2.14, p<0.0001) were associated with increased treatment uptake. Black race (OR 0.9, p=0.001,
ref=White) and Hispanic ethnicity (OR 0.89, p=0.002, ref=White), injection drug use (OR 0.79,
p<0.0001), alcohol use disorder (OR 0.7, p<0.0001), HIV (OR 0.74, p<0.0001), and having a mental
health diagnosis (OR 0.68, p<0.0001) were associated with decreased treatment uptake.
In this initial analysis of HCV treatment uptake among a national cohort of Medicaid enrollees, we
found disparities in treatment uptake based on demographic factors, injection drug use, and other
co-morbidities. Further work will examine geographic and policy differences in treatment patterns,
and changes over time.
Disclosure of Interest Statement:
This work was funded by the National Institute on Drug Abuse (K01 DA048172 to SNK and P30
DA040500) and the National Institute of Diabetes, Digestive and Kidney Diseases (R01 DK123205 to
MS and R01 DK123205-02S1 to CG). The contents of this publication are solely the responsibility of
the authors and do not necessarily represent the views of the funding agencies or the US
government. Dr. Kapadia has received research grants paid to his institution from Gilead Sciences
Inc, unrelated to the current study. All other authors report no potential conflicts of interest.

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