Nearly 40% of people with hepatitis C are uninsured
Relatively little is known about the health insurance status of people living with hepatitis C and its impact on access to treatment. A new study in the respected journal Hepatology examined these issues using data from the National Health and Nutrition Examination Survey (NHANES), a large household survey overseen by the Centers for Disease Control and Prevention (CDC).
Here’s the abstract for the study:
Hepatology. 2010 Dec 17. doi: 10.1002/hep.24131. [Epub ahead of print]
Insurance status and treatment candidacy of hepatitis C patients: Analysis of population-based data from the United States.
Stepanova M, Kanwal F, El-Serag HB, Younossi ZM.
Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
Successful treatment with antiviral therapy could potentially reduce morbidity and mortality in patients with hepatitis C virus (HCV) infection. However, at the population level, these benefits may be offset by a limited number of patients who have access to antiviral treatment. Using data from the National Health and Nutrition Examination Survey conducted in 2005-2008, we analyzed the health insurance status and treatment candidacy of HCV-positive (HCV+) individuals. A total of 10,582 subjects were examined; of those, 1.16% had detectable HCV RNA and were defined as HCV+. The HCV+ patients were less likely to be insured than HCV-negative individuals (61.2% versus 81.2%; P = 0.004). Among those with health insurance, HCV+ patients were less likely to have private insurance, whereas the coverage by Medicare/Medicaid and other government-sponsored plans was similar to the rest of the population. In multivariate analysis, HCV infection was an independent predictor of being uninsured even after adjustment for demographic disparity of the HCV+ cohort (odds ratio, 0.43; 95% confidence interval, 0.24-0.78). Of all HCV+ patients, 66.7% were eligible for anti-HCV treatment. However, only 54.3% of HCV+ treatment candidates had any type of insurance coverage. Finally, only 36.3% of HCV+ patients were potentially eligible for treatment and had health insurance. Conclusion: A high proportion of HCV+ patients are currently uninsured, and many have publicly funded health insurance. Among those who could be candidates for treatment, the rate of insurance coverage is even lower. These findings can have important implications for health insurance coverage of these patients under the new health care reform legislation in the United States.
The study had several other significant findings:
- People with hepatitis C were more likely to report histories of substance use (alcohol, smoking, marijuana, opiates or methamphetamine)
- People with hepatitis C were nearly three times more likely to report a visit to a mental health specialist in the past year
- People with hepatitis C were more likely to report depression, arthritis, and chronic obstructive pulmonary disease (COPD)
- A history of cocaine, heroin, or methamphetamine use was independently associated with uninsurance.
In their discussion of the results of the study, the authors conclude:
We also found that HCV+ individuals without health insurance were more likely to report history of alcohol abuse and were less likely to be educated than insured. It is plausible that the high prevalence of social comorbidity and lack of education may still hamper treatment acceptance and initiation among individuals after they are diagnosed with HCV infection. To make any impact on the burden of HCV and to cover the gap between efficacy and effectiveness, not only more individuals need to be screened for and diagnosed with HCV, but more focus is needed on HCV-related social services and education—comprehensive HCV care that may be best delivered through medical homes using the chronic care model approach….
…In conclusion, a high proportion of HCV+ individuals in the United States are currently uninsured, and many have publicly funded health insurance. Among those who could potentially be candidates for treatment, the rate of insurance coverage is even lower. Although newer treatment regimens with direct acting antivirals may increase efficacy, it will certainly increase the costs of antiviral treatment in HCV—thus further limiting access to treatment for the uninsured/underinsured. This issue of access to care for HCV patients is critical and must be considered by policy makers. We believe that our results can have important implications for health insurance coverage of HCV-infected patients and should be considered under the new health care reform legislation.