246241 Hepatitis C virus (HCV) testing and diagnosis rates in the commercially insured and Medicare populations in the U.S

Monday, October 31, 2011: 1:05 PM

Baris Deniz, MSc , Vertex Pharmaceuticals Incorporated, Cambridge, MA
Bruce Pyenson, FSA, MAAA , Milliman, Inc, New York, NY
Kosuke Iwasaki, FIAJ, MAAA , Milliman, Inc, New York, NY
Camilla S. Graham, MS, MPH , Vertex Pharmaceuticals Incorporated, Cambridge, MA
Introduction: Hepatitis C virus (HCV) infection is the most common blood-borne disease in the U.S., with an estimated 4.1 million individuals (1.6% of the population) testing positive for anti-HCV antibodies. Chronic HCV infection may lead to liver failure, hepatocellular carcinoma, and liver transplant. However, ~75% of infected patients remain undiagnosed.

Methods: To study the relationship between U.S. testing and diagnosis trends, we analyzed the 2004-2008 Thompson MedStat Marketscan and the Medicare 5% sample databases. Patients tested were identified using outpatient claim and CPT codes for diagnostic tests. Medical claims were analyzed to identify testing outcome using ICD-9 codes. For the commercially insured population, the percentage being treated following diagnosis was identified using HCPCS/NDC codes.

Results: Annual HCV testing rates for commercial and Medicare populations were 1.1% and 1.7%, respectively, and 2% and 9% of the tested population was diagnosed, respectively. HCV testing was more common among younger patients among whom HCV prevalence is low, and less common among “baby boomers” (1946-1964), who account for up to two-thirds of the HCV-infected population. Overall, 19% of the commercially insured population received treatment within one year following initial diagnosis.

Conclusions: HCV testing rates in the commercially insured and Medicare populations were low in 2004-2008 in the U.S. These findings may partially explain the high percentage of undiagnosed patients. Treatment within one year following diagnosis was 19% in the commercially insured population. Further studies are needed to explore other potential causes for low testing and diagnosis rates in the U.S.

Learning Areas:
Chronic disease management and prevention
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
1. Describe the current burden of HCV disease and its impact on public health in the United States. 2. Identify potential reasons for the low rates of screening and diagnosis of HCV-infected patients. 3. Evaluate the presented data on screening, diagnosis, and treatment in the commercially insured and Medicare populations. 4. Discuss the importance of improved screening, diagnosis, and treatment in the effective management of HCV infection.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: 1) participated in the conception, design, acquisition of data, analysis and interpretation of data; 2) participated in the development and critical revision of the abstract; and 3) approved the final version to be submitted.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Vertex Pharmaceuticals Inc. Medical Affairs Employment (includes retainer) and Stock Ownership

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Viral hepatitis
See more of: Epidemiology