1
|
Clements KM, Kunte PS, Clark MA, Gurewich D, Greenwood BC, Sefton L, Pratt C, Person SD, Wessolossky MA. Uptake of hepatitis C virus treatment in a multi-state Medicaid population, 2013-2017. Health Serv Res 2022; 57:1312-1320. [PMID: 35466398 PMCID: PMC9643082 DOI: 10.1111/1475-6773.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine trends in the direct acting antiviral (DAA) uptake in a multi-state Medicaid population with hepatitis C virus (HCV) prior to and after ledipasvir/sofosbuvir (LDV/SOF) approval and changes in prior authorization (PA) requirements. DATA SOURCES Analyses utilized enrollment, medical, and pharmacy claims in four states, December 2013-December 2017. STUDY DESIGN An interrupted time series examined trends in uptake (1+ claim for a DAA) before and after two events: LDV/SOV approval (October 2014) and lifting of PA requirements for 40% of members (July 2016). Analyses were also performed in subgroups defined by the number and dates of change in PA requirements in members' Medicaid plans. DATA COLLECTION/EXTRACTION METHODS Members aged 18-64 years with an ICD code for HCV were included in the sample from diagnosis date until treatment initiation or Medicaid disenrollment. PRINCIPAL FINDINGS The annual sample size ranged from 38,302 to 45,005 with approximately 30% ages 18-34 years and 40% female. In December 2013, 0.08% was treated, rising to 0.74% in December 2017 (p < 0.001). Uptake increased from 0.34%/month in October 2014 to 0.70%/month after LDV/SOF approval, (p < 0.001), and increased relative to the pre-LDV/SOV trend through June 2016 (p = 0.04). Uptake increased to 1.18%/month after PA change, (p < 0.001) and remained flat through 2017 (p = 0.64). Cumulatively, 20.1% were treated by December 2017. In plans with few/no requirements through 2017, uptake increased to 1.19%/month after LDV/SOF approval (p < 0.001) and remained flat through 2017 (p = 0.11), with 22.2% cumulatively treated. Among plans that lifted PA requirements from three to zero in mid-2016, uptake did not increase after LDV/SOF approval (p = 0.36) but did increase to 1.41%/month (p < 0.001) after PA change, with 18.1% cumulatively treated. CONCLUSIONS HCV Treatment increased through 2017. LDV/SOF approval and lifting PA requirements led to an increase in uptake followed by flat monthly utilization. Cumulative uptake was higher in plans with few/no PA requirements relative to those with three requirements through mid-2016.
Collapse
Affiliation(s)
- Karen M. Clements
- Commonwealth MedicineUniversity of Massachusetts Chan Medical SchoolShrewsburyMassachusettsUSA
| | - Parag S. Kunte
- Commonwealth MedicineUniversity of Massachusetts Chan Medical SchoolShrewsburyMassachusettsUSA
| | - Melissa A. Clark
- Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Deborah Gurewich
- Center for Healthcare Organization and Implementation ResearchVA Boston Health Care System Jamaica Plain CampusBostonMassachusettsUSA
| | - Bonnie C. Greenwood
- Commonwealth MedicineUniversity of Massachusetts Chan Medical SchoolShrewsburyMassachusettsUSA
| | - Laura Sefton
- Commonwealth MedicineUniversity of Massachusetts Chan Medical SchoolShrewsburyMassachusettsUSA
| | - Carter Pratt
- Commonwealth MedicineUniversity of Massachusetts Chan Medical SchoolShrewsburyMassachusettsUSA
| | - Sharina D. Person
- Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Miryea A. Wessolossky
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| |
Collapse
|
2
|
Tam E, Tremblay J, Fraser C, Conway B, Ramji A, Borgia S, Tsoi K, Yoshida EM, Rajendran B, Macphail G, Wong A, Cooper C, Patel K, Puglia M, Stewart K, Trottier B, Deshaies L, Doucette K, Ghali P, Lee S, Halsey-Brandt J, Trepanier JB. The Z-Profile Study: a multicenter, retrospective cohort study to assess the real-world use and effectiveness of elbasvir/grazoprevir in Canadian adult patients with chronic hepatitis C. CANADIAN LIVER JOURNAL 2020; 3:251-262. [DOI: 10.3138/canlivj-2019-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/30/2019] [Indexed: 11/20/2022]
Abstract
Background: Canada was the first country to approve elbasvir/grazoprevir (EBR/GZR) for the treatment of chronic HCV infection for genotypes 1 and 4 with or without ribavirin and genotype 3 with sofosbuvir, with no recommendation for baseline resistance testing. The aim of this study was to describe the effectiveness of EBR/GZR and the profile of patients selected for treatment in a Canadian real-world setting. Methods: This multicenter retrospective study of HCV-infected patients treated with EBR/GZR took place among selected Canadian health care providers, with no exclusion criteria. Primary outcome measures included parameters associated with patient profile and sustained virologic response at 12 weeks (SVR12) and 24 weeks after treatment. Results: A total of 408 patients were included; 244 had available SVR12 information (per-protocol population [PP]). Genotype distribution included 1a (54.7%), 1b (17.2%), 3 (11.8%), 4 (10.0%), and other (6.4%). The majority (88.7%) of participants were treated for 12 weeks without ribavirin. Fifty-nine (14.5%) participants, predominantly with genotype 1a (49/59) infection, were tested for baseline resistance-associated substitutions (bRAS). SVR12 was achieved by 95.9% of the PP. In an exploratory analysis assessing potential predictors of SVR12, participants who had undergone bRAS testing (OR 0.14, 95% CI 0.03–0.64) and participants who had undergone liver transplant (OR 0.05, 95% CI 0.00–0.68) had significantly lower odds of achieving SVR12. Conclusions: This study supports the real-world effectiveness of EBR/GZR—including a broad range of genotypes and diverse fibrosis stages—in the absence of bRAS testing and in special populations.
Collapse
Affiliation(s)
- Edward Tam
- LAIR Centre, Vancouver, British Columbia, Canada
| | | | - Chris Fraser
- The Cool Aid Community Health Centre, Victoria, British Columbia, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Alnoor Ramji
- Gastroenterology Division, GI Research Institute (GIRI), Vancouver, British Columbia, Canada
| | - Sergio Borgia
- William Osler Health System, Brampton, Ontario, Canada
| | - Keith Tsoi
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Eric M Yoshida
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Gisela Macphail
- Calgary Urban Project Society (CUPS), Calgary, Alberta, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Keyur Patel
- University Health Network, Toronto, Ontario, Canada
| | - Marco Puglia
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Benoit Trottier
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Quebec, Canada
| | | | - Karen Doucette
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Ghali
- McGill University Health Center, Montreal, Quebec, Canada
| | - Samuel S Lee
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | | | | |
Collapse
|
3
|
Gitto S, Gamal N, Andreone P. NS5A inhibitors for the treatment of hepatitis C infection. J Viral Hepat 2017; 24:180-186. [PMID: 27925362 DOI: 10.1111/jvh.12657] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
Abstract
Today, we are witnessing a new era for the treatment of hepatitis C with excellent rates of virologic response and very good safety profiles. Among the many classes of direct-acting antivirals, the inhibitors of nonstructural protein 5A are particularly interesting. NS5A is a phosphorylated protein with a relevant role in viral replication. HCV-NS5A inhibitors show high potency, very good safety profile and high barrier to resistance. The amazing in vitro effectiveness of this class is associated with great efficacy in clinical trials in combination protocols with antivirals of other classes, with sustained virological response (SVR) obtained in more than 90% of patients. Herein, we sought to review the current knowledge regarding the NS5A protease complex inhibitors with special emphasis on clinical efficacy and development of viral resistance.
Collapse
Affiliation(s)
- Stefano Gitto
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nesrine Gamal
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Andreone
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|