Coordinated Care Enhances Access to Hepatitis C Antiviral Treatment

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Patients with Medicaid had an average of 4.6 days longer for insurance approval compared with non-Medicaid patient.
Patients with Medicaid had an average of 4.6 days longer for insurance approval compared with non-Medicaid patient.

Coordinated care has the potential to improve access to treatment for individuals with hepatitis C who are naive to direct-acting antivirals; however, having Medicaid could hamper access, according to a recent study published in PLoS ONE.

Investigators sought to provide an update on current research aimed to determine reasons some individuals and groups did not advance through the hepatitis C care continuum. Treatment for hepatitis C with direct-acting antivirals began with a referral to the program Vanderbilt University Medical Center Infectious Diseases Clinic. Then, the treatment team, made up of 3 physicians, 1 clinical pharmacist, 1 pharmacy technician, and 1 nurse provided integrated care to each person in the study who had been diagnosed with chronic hepatitis C. The pharmacist played a vital role in identifying and alleviating “adverse effects that may have led to treatment discontinuation and enabled patients with counseling and adherence tools to ensure treatment completion.”

Study investigators examined data from October 2015 to July 2016 retrospectively and conducted a prospective data examination from August 2016 to September 2016. A total of 187 people met criteria to receive a referral to the clinic. The main study end point was a sustained virologic response for 12 weeks or more following treatment completion.

Results showed that 64% (n=120) of the participants completed an evaluation for treatment, 64% (n=119) were prescribed treatment, 61% (n=114) obtained approval for treatment, 60% (n=113) started treatment, 57% (n=107) completed treatment, and 53% (n=100) achieved sustained virologic response. Of the participants who successfully started direct-acting antivirals, 95% completed the full course of treatment. There were 3 patients who suffered virologic failure.

The researchers identified some significant differences between people with Medicaid and those without it. The likelihood of finishing an evaluation decreased by 79% (OR 0.21; 95% CI, 0.10-0.45; P<.001) when compared with non-Medicaid.  Researchers also found the “rate in days to approval decreased by 73% in patients with Medicaid compared with non-Medicaid (HR 0.27; 95% CI, 0.15-0.48; P<.001), reflecting a longer time to treatment approval.”

The study had a number of limitations (eg, non-blind, single-site study, and small sample size). A large portion of the people studied had a co-occurring HIV infection (n=149) which affects the generalizability of the findings.

“Despite modern challenges for [hepatitis C] treatment including high pharmaceutical cost and a large population of patients with ongoing illicit substance use, this study demonstrated real-world efficacy of coordinated treatment programs.” Researchers note “[to] facilitate initiation and completion of [hepatitis C] treatment, providers should place an emphasis on engaging this population with social workers, case managers, and addiction counselors.” Researchers also emphasized “integration of pharmacy services demonstrated high rates of medication access compared to previous studies, even in those with Medicaid.” 

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Reference

Zuckerman A, Douglas A, Nwosu S, Choi L, Chastain C. Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral eraPLoS One. 2018; 13(6):e0199174.

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