Interferon-Free Regimens for Chronic Hepatitis C: Barriers Due to Treatment Candidacy and Insurance Coverage

Abstract

Background: Recently developed interferon- and ribavirin-free regimens to treat hepatitis C virus infection (HCV) have low side effect profile accompanied by high efficacy. Aim: To assess the potential access to these regimens using the most recent data on candidacy and insurance coverage for HCV-positive Americans. Methods: The National Health and Nutrition Examination Survey (NHANES) cycles 2005–2008 and 2009–2012 were used in this cross-sectional study. Results: A total of 10,799 and 11,840 adult (18+) NHANES participants were included from the two cycles, respectively. Of these, 1.19 and 0.94 %, respectively, showed detectable viremia (HCV+). The proportion of HCV+ individuals aged ≥65 increased from 1.7 to 6.8 % (p = 0.0144). HCV+ individuals were less likely to be insured than HCV− regardless of the study year (HCV+: 63.8 % vs. HCV−: 80.1 %, p = 0.0005). Between the study cycles, the rates of insurance coverage (60.2 and 67.4 %, respectively) and treatment eligibility based on medical contraindications for interferon-based treatment (66.6 and 74.1 %, respectively) were not different (p > 0.05). With minimal contraindications for interferon- and ribavirin-free treatment, 95.1 and 97.7 % of HCV+ patients could be eligible for treatment despite aging of the study population and unchanged rates of comorbid conditions. Considering both treatment eligibility and insurance coverage, potential access to anti-HCV treatment increased from 35.1 % for interferon-based to 66.6 % for interferon-free regimens (p = 0.0003). Conclusions: A large proportion of HCV+ individuals remain uninsured or under-insured. The lack of adequate coverage limits their access to the newly developed interferon- and ribavirin-free regimens for HCV that are highly effective with minimal contraindications.