title: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. zobair.younossi@inova.org.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA. zobair.younossi@inova.org.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009749:Nutrition Surveys; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents
keywords: Direct-acting antiviral agents; Health services accessibility; Hepatitis C; Interferon