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

Authors

  • Maria Stepanova,

    1. Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA
    2. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
    Search for more papers by this author
  • Fasiha Kanwal,

    1. John Cochran VA Medical Center and Saint Louis University School of Medicine, St. Louis, MO
    Search for more papers by this author
  • Hashem B. El-Serag,

    1. Michael E. DeBakey VA Medical Center and Baylor College of Medicine,Houston, TX
    Search for more papers by this author
  • Zobair M. Younossi

    Corresponding author
    1. Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA
    2. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA
    • Center for Liver Diseases, InovaFairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042. E-mail: zobair.younossi@inova.org;===

    Search for more papers by this author

  • Potential conflict of interest: Dr. Younossi consults for Biolex, Vertex, and Tibotee.

  • Supported in part by the Liver Outcomes Research Fund of The Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA.

Abstract

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 a limited number of patients who have access to antiviral treatment. Using data from the National Health and Nutrition Examination Survey conducted in 2005-2008, we analyzed the health insurance status and treatment candidacy of HCV-positive (HCV+) individuals. A total of 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-negative individuals (61.2% versus 81.2%; P = 0.004). Among those with health insurance, HCV+ patients were less likely to have private insurance, whereas 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% confidence interval, 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. Conclusion: 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 health care reform legislation in the United States. (HEPATOLOGY 2011)

Ancillary