The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially Insured Population

Abstract

Background. Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States. Methods. We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure. Results. Among 120, 311 individuals estimated to have HCV viremia in Optum during the study period, 109, 233 (90.8%; 95% CI, 90.6%-91.0%) had a recorded diagnosis of HCV infection, 75, 549 (62.8%; 95% CI, 62.5%-63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41, 102 (34.2%; 95% CI, 33.9%-34.4%) were dispensed DAA treatment, and 25, 760 (21.4%; 95% CI, 21.2%-21.6%) were assessed for cure. Conclusions. Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals.