Interferon-Free Regimens for Chronic Hepatitis C: Barriers Due to Treatment Candidacy and Insurance Coverage
Interferon-Free Regimens for Chronic Hepatitis C: Barriers Due to Treatment Candidacy and Insurance Coverage
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DOI：
10.1007/s10620-015-3709-6
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发表时间：
2015-11-01
影响因子：
3.1
通讯作者：
Younossi, Zobair M.
中科院分区：
文献类型：
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作者：
Stepanova, Maria;Younossi, Zobair M.
最近开发的治疗丙型肝炎病毒感染（HCV）的无干扰素和利巴韦林方案副作用低，疗效高。使用有关HCV阳性美国人候选资格和保险范围的最新数据来评估这些方案的潜在可及性。国家健康和营养检查调查（NHANES）周期2005-2008年和2009年-2012年在这个横断面研究中使用。总共有10,799和11,840成人（18+）NHANES参与者分别从两个周期。其中，分别有1.19%和0.94%显示可检测的病毒血症（HCV+）。年龄在千分之一日元65的HCV+个体的比例从1.7%增加到6.8%（p = 0.0144）。无论研究年份如何，HCV+个体投保的可能性低于HCV-（HCV+：63.8% vs. HCV-：80.1%，p = 0.0005）。两个研究周期之间，保险覆盖率（分别为60.2%和67.4%）和基于干扰素治疗的医学禁忌症的治疗资格（分别为66.6%和74.1%）没有差异（p > 0.05）。无干扰素和利巴韦林治疗的禁忌症最少，95.1%和97.7%的HCV+患者有资格接受治疗，尽管研究人群老龄化和共病率不变。考虑到治疗资格和保险范围，抗HCV治疗的潜在可及性从基于干扰素的方案的35.1%增加到无干扰素方案的66.6%（p = 0.0003）。缺乏足够的覆盖面限制了他们获得新开发的无干扰素和利巴韦林的HCV治疗方案，这些方案非常有效，禁忌症最少。
Recently developed interferon- and ribavirin-free regimens to treat hepatitis C virus infection (HCV) have low side effect profile accompanied by high efficacy.To assess the potential access to these regimens using the most recent data on candidacy and insurance coverage for HCV-positive Americans.The National Health and Nutrition Examination Survey (NHANES) cycles 2005-2008 and 2009-2012 were used in this cross-sectional study.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 a parts per thousand yen65 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).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.