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VA Successfully Implements Interferon-free Treatment for Hepatitis C Virus in Previously Undertreated Patient Populations


BACKGROUND:
Interferon-free direct-acting antiviral regimens have become the primary treatment of chronic hepatitis C virus (HCV) infection, with sustained viral response being achieved by 90% or more of those treated. Moreover, the new regimens are easier to administer, have a shorter duration of treatment, and have fewer side effects than interferon-containing treatments. Yet the high cost of interferon-free treatment has limited its use throughout the world despite the high prevalence of HCV infection. This study examined the adoption of interferon-free treatment for HCV in VA to learn who received this therapy and whether the limitations of interferon-containing treatments have been overcome, including low rates of use among VA healthcare users who are African American or Hispanic, and among those with HCV-HIV co-infection. Using VA data, investigators identified Veterans who received treatment for chronic HCV infection from FY2010 through FY2015 (n=206,544). Investigators then examined lab test results, pharmacy records, inpatient and outpatient use, patient demographics and comorbidities. Sustained viral response (SVR) was defined with the definition used in clinical trials and for regulatory approval.

FINDINGS:

  • With the advent of interferon-free regimens, the percentage of VA patients with HCV infection that was treated increased from 2.4% in 2010 to 18.1% in 2015, an absolute increase of 15.7%.
  • There were large treatment gains realized by groups of patients that had been less likely to be treated in 2010. Large absolute increases in the percentage treated were achieved in Veterans with HIV co-infection (19%), alcohol use disorder (12%), and drug use disorder (13%), and in Veterans who were African-American (14%) or Hispanic (14%).
  • Veterans with mental illnesses exacerbated by interferon, depression, PTSD, and bipolar disorder, had absolute increases in treatment that were larger than the overall increase.

IMPLICATIONS:

  • In 2015, the VA healthcare system spent $962 million on interferon-free treatments, which was 1.5% of its total operating budget. This was made possible by a special $1 billion Federal appropriation and negotiated medication discounts. Lacking this – and despite U.S. guidelines recommending treatment of all patients with HCV infection – other health plans are limiting treatment, which raises concerns about equity and efficiency.

LIMITATIONS:

  • Data used in this analysis ended in 2015. Current data indicate that VA has now successfully treated more than 100,000 patients for HCV.
  • Investigators did not have information regarding non-VA care.
  • Investigators did not control for changes in Veteran eligibility, which can affect co-payments.

AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 12-059). Drs. Barnett and Gidwani-Marszowski are part of HSR&D's Health Economics Resource Center (HERC) in Menlo Park, CA.


Barnett P, Joyce V, Gidwani-Marszowski R, et al., and Owens D. The Effect of Interferon-Free Regimens on Disparities in Hepatitis C Treatment of U.S. Veterans. Value in Health. March 7, 2018; Epub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.