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Although hepatitis C infection is a highly curable disease, few insured patients diagnosed received direct-acting antiviral (DAA) treatment during 2019-2020, while disparities contributed to treatment delays, according to new CDC data appearing in an early edition of the .

Adjusted multivariable regression analysis showed Medicaid recipients were least likely to initiate DAA treatment within 360 days of testing positive for hepatitis C infection (23%). Medicare recipients fared somewhat better (28%), as did individuals with private insurance (35%).

Adjusted odds ratios relative to private insurance for receiving DAA therapy were:

• Medicaid: 0.54, 95% CI 0.51–0.57
• Medicare: 0.62, 95% CI 0.56–0.68

And among those treated at some point, more with private insurance received it within 180 days of initial diagnosis (84%) compared with those on Medicaid (75%) or Medicare (77%), reported Carolyn Wester, MD, MPH, director of the Division of Viral Hepatitis at the CDC, and colleagues.

Medicaid is the least likely insurer to cover DAA treatment, so it was no surprise that residents of states with Medicaid treatment restrictions were less likely to initiate treatment, versus those in states without them (aOR 0.77, 95% CI 0.74–0.81).

Hepatitis C viral infection impacts over 2 million Americans with incidence on the rise -- especially among young individuals with injection drug use -- and leads to 14,000 annual deaths nationally. Eight to 12 weeks of DAA treatment is recommended to effectively cure 95% or more hepatitis C cases. Despite this, only about 1.2 million individuals initiated DAA treatment from 2014 to 2020, which remains far below the national elimination goal as fewer seek treatment.

"Everyone with hepatitis C should have access to lifesaving treatment, regardless of race, ethnicity, age or insurance status," said CDC Acting Principal Deputy Director Debra Houry, MD, MPH, . "What these data tell us is that at best, only one in three people are treated within a year of being diagnosed and we must reduce the barriers and get more people treated for hepatitis C in our country. This is critical to stop preventable deaths and prevent new infections."

For this report, CDC researchers retrospectively examined Health Verity data on over 2 million patients with hepatitis C across all 50 states and the District of Columbia from Jan. 30, 2019, to Oct. 31, 2020. Those included were adults ages 18-69, who were continuously insured for at least 60 days before and at least 360 days after their diagnosis. The analysis adjusted for demographics, insurance payor, and Medicaid restrictions.

Younger people – ages 18-39 – on Medicaid or private insurance had the lowest rates of treatment initiation, versus those ages 50-59. Across all insurance plans, men had consistently lower odds of initiating treatment than did women.

Among Medicaid recipients, odds of treatment initiation were lower for Black individuals (aOR, 0.93, 95% CI 0.88–0.99) or those coded as "other" for race (aOR 0.73, 95% CI 0.62–0.88), versus whites.

To increase treatment access, researchers suggested removing eligibility restrictions/preauthorization requirements, providing treatment where patients already receive services in as few visits as possible, and expanding primary care providers who can treat hepatitis C.

"People shouldn't have to jump over hurdles to access lifesaving, cost-effective treatment," said Wester in the CDC's press release. "Removing barriers to treatment is a critical step, as is increasing screening for hepatitis C. We estimate about 40% of people with hepatitis C in the U.S. are unaware of their infection -- testing is the first step to accessing curative treatment."

Wester and colleagues acknowledged that the findings may not be generalizable to all hepatitis C patients, since those incarcerated or uninsured were excluded. Treatment initiation rates could have been overestimated, while data on ethnicity were missing for 61% of people included in the analysis.

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