Top 5 Takeaways

1. Low Treatment Rates Across Age and Insurance Types: Direct-acting antiviral (DAA) treatment rates for hepatitis C are notably low, especially among young adults aged 18–29 years and Medicaid recipients, highlighting significant disparities in access to this life-saving treatment.
2. Impact of Medicaid Treatment Restrictions: Within Medicaid, treatment initiation is lower among persons in states with treatment restrictions, and among individuals identifying as Black or of other races, underscoring the need for policy changes to improve equity in treatment access.
3. Disparities in Treatment Initiation: Treatment initiation within 360 days of diagnosis varies significantly by insurance type, with private insurance recipients having the highest rates (35%), followed by Medicare (28%) and Medicaid (23%), indicating insurance type as a barrier to timely treatment.
4. Significance of Timely DAA Treatment: Timely initiation of DAA treatment is crucial for reducing hepatitis C virus-related mortality, disparities, and transmission, emphasizing the need for unrestricted access to DAA treatment across all insurance types.
5. Recommendations for Public Health Practice: Enhancing access to hepatitis C treatment, especially for Medicaid and Medicare recipients, and removing Medicaid treatment restrictions are critical steps towards achieving hepatitis C elimination goals.

Original Article Author and Citation

Corresponding Author

Carolyn Wester, nhe3@cdc.gov.

Suggested Citation

Thompson WW, Symum H, Sandul A, et al. Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:1011-1017. DOI: http://dx.doi.org/10.15585/mmwr.mm7132e1.

Summary

This article highlights the urgent need for improved access to hepatitis C treatment among insured adults in the United States, focusing on disparities related to age, race, and insurance type. Despite the high efficacy of DAA treatments, which can cure over 95% of cases, treatment rates remain low, particularly among young adults and Medicaid recipients. The report emphasizes the importance of timely DAA treatment initiation to reduce hepatitis C virus-related mortality, disparities, and transmission.

Methods

The study used data from HealthVerity to construct a cohort of adults aged 18–69 years with diagnosed hepatitis C infection, analyzing the association between DAA treatment initiation and factors such as sex, age, race, insurance payor, and Medicaid restriction status through multivariable logistic regression.

Discussion

Disparities in DAA treatment initiation are evident, with lower rates among Medicaid and Medicare recipients compared to those with private insurance. The analysis also reveals that treatment initiation is particularly low among young adults and individuals in states with Medicaid treatment restrictions. These disparities highlight the need for policy interventions to improve access to hepatitis C treatment.

Conclusion

To reduce hepatitis C virus-related mortality, disparities, and transmission, it is crucial to ensure unrestricted access to DAA treatment for all individuals, regardless of insurance type or state-imposed Medicaid treatment restrictions. Public health efforts should focus on removing barriers to treatment and promoting timely initiation of DAA therapy.

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