Insurance status and treatment candidacy of patients with hepatitis C: Analysis of population-based data from the United States

Hepatology
Accepted Article (Accepted, unedited articles published online for future issues)

Maria Stepanova 1,4, Fasiha Kanwal 2, Hashem B. El-Serag 3, Zobair M. Younossi 1,4,*,‡
 
DOI: 10.1002/hep.24131
Copyright © 2010 American Association for the Study of Liver Diseases

Author Information
1 Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA
2 John Cochran VA Medical Center and Saint Louis University School of Medicine, St Louis, MO
3 Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX
4 Betty and Guy Beatty Center for Integrated Research, Inova Health System Falls Church, VA, USA
Email: Zobair M. Younossi (zobair.younossi@inova.org)

* Correspondence: Zobair M. Younossi, Center for Liver Diseases, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042
† Conflicts of interest: There are no conflicts of interest for any of the authors.
‡ Ph: (703) 776-2540; Fax: (703) 776-4386

Publication History
Accepted manuscript online: 17 DEC 2010 03:44PM EST
Manuscript Accepted: 9 DEC 2010
Manuscript Revised: 3 DEC 2010
Manuscript Received: 1 SEP 2010

Funded by
Liver Outcomes Research Fund of The Center for Liver Diseases
Inova Fairfax Hospital, Falls Church, Virginia

Abstract
 
Background:
Successful treatment with antiviral therapy could potentially reduce morbidity and mortality in patients with hepatitis C virus (HCV) infection. However, at the population level, these benefits may be offset by limited number of patients who have access to antiviral treatment.

Methods:
Using National Health and Nutrition Examination Survey (NHANES) conducted in 2005-2008, we analyzed health insurance status and treatment candidacy of HCV+ individuals.

Results:
Total 10,582 subjects were examined; of those, 1.16 % had detectable HCV RNA and were defined as HCV+. The HCV+ patients were less likely to be insured than HCV- individuals (61.2% vs. 81.2%, P = 0.004). Among those with health insurance, HCV+ patients were less likely to have private insurance, while the coverage by Medicare/Medicaid and other government-sponsored plans was similar to the rest of the population. In multivariate analysis, HCV infection was an independent predictor of being uninsured even after adjustment for demographic disparity of the HCV+ cohort [odds ratio = 0.43 (95% CI = 0.24-0.78)]. Of all HCV+ patients, 66.7% were eligible for anti-HCV treatment. However, only 54.3% of HCV+ treatment candidates had any type of insurance coverage. Finally, only 36.3% of HCV+ patients were potentially eligible for treatment and had health insurance.

Conclusions:
A high proportion of HCV+ patients are currently uninsured, and many have publicly funded health insurance. Among those who could be candidates for treatment, the rate of insurance coverage is even lower. These findings can have important implications for health insurance coverage of these patients under the new healthcare reform legislation. (HEPATOLOGY 2010.)

Source