Insured women were 15 times more likely to initiate hepatitis treatment


Disclosures: Edmonds reports receiving institutional grants from NIH the National Institute of General Medical Sciences and travel support from the Society for Epidemiologic Research. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

  • Women with health insurance were significantly more likely to start hepatitis C treatment than uninsured women.
  • Women with other types of insurance are more likely to initiate DAAs than women with Medicaid.

Women who reported having health insurance were significantly more likely to initiate hepatitis C treatment vs. women without health insurance, according to a study published in Clinical Infectious Diseases.

“Direct-acting antivirals (DAAs) are highly effective at curing hepatitis C and are recommended for most people. However, the high cost of these newer medications is a major barrier to access,” Andrew Edmonds, PhDs, associate professor in the department of epidemiology at the University of North Carolina Chapel Hill, told Healio.

Edmonds A, et al. Clin Infect Dis. 2023;doi:10.1093/cid/ciad204.

“We wanted to rigorously examine the relationship between having health insurance and starting direct-acting antiviral therapy among women with HIV and hepatitis C virus (HCV),” Edmonds said.

To do so, the researchers assessed women who were part of the Women’s Interagency HIV Study. Women in the cohort with HIV and HCV who reported no prior hepatitis C treatment were followed for DAA initiation between 2015 and 2019.

The researchers then assessed the relationship between time-varying health insurance status and DAA initiation and estimated weighted cumulative incidences of DAA initiation by health insurance status.

In total, 139 women were included in the study — 86% of whom reported being insured at baseline. After assessing 439 semiannual visits, 88 women (63%) reported DAA initiation.

According to the study, the researchers determined that health insurance increased the likelihood of reporting DAA initiation at a given visit (RR = 4.94; 95% confidence limit [CL], 1.92-12.8) vs. no health insurance. The incidence of DAA initiation was even higher among insured women at 2 years (51.2%; 95% CL, 43.3%-60.6%) compared with uninsured women (3.5%; 95% CL, 0.8%-14.6%).

Additionally, the study showed that Medicaid was the most common type of insurance reported by study participants (87%), which the researchers said was “elemenprising” based on the low reported incomes — 85% had annual household incomes of $18,000 or less.

Andrew Edmonds

Sensitivity analyzes suggested that women on Medicaid were more likely to initiate DAAs than women without insurance. However, effect estimates from analyzes of the full sample indicated that those with other insurance types were more likely to start HCV treatment, according to the study.

“This study emphasizes health insurance as an essential way to reduce financial barriers to hepatitis C treatment access for low-income women with HIV and HCV,” Edmonds said. “It supports the implementation of interventions to increase health insurance coverage, such as Medicaid expansion and the elimination of state-specific Medicaid restrictions for direct-acting antivirals as a means by which to increase receipts of HCV curative therapy for this and similar populations.”

He added that without further policy action to decrease the number of vulnerable individuals who are uninsured, “too few individuals will access these potentially life-saving medications.”

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