University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.
University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
Public Health Rep. 2023 May-Jun;138(3):467-474. doi: 10.1177/00333549221099323. Epub 2022 Jun 8.
Until November 1, 2018, Illinois Medicaid restricted coverage of hepatitis C virus (HCV) medication to patients with sobriety from alcohol and illicit substances for ≥12 months. This policy limited treatment access for patients with a high risk of HCV transmission, despite clinical trial and real-world data demonstrating high sustained virologic response (SVR) rates among patients with substance use. The objective of this study was to compare HCV SVR rates between patients treated before and after removal of the Illinois Medicaid sobriety restriction.
We performed a retrospective cohort study of Medicaid-insured patients who completed direct-acting antiviral treatment at an urban, academic medical center in Illinois from January 1, 2014, through October 21, 2020. The primary endpoint was SVR. We compared group characteristics using χ or Fisher exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. We used logistic regression to compare SVR rates before and after the policy change, adjusting for differences between groups.
A total of 496 patients (348 pre-policy change; 148 post-policy change) started treatment; excluding loss to follow-up/early discontinuation, SVR rates were 95.4% (309 of 324) pre-policy change and 97.1% (134 of 138) post-policy change. SVR rates did not differ after adjusting for the use of historic HCV regimens and the higher cirrhosis rate in the pre-policy change group compared with the post-policy change group (odds ratio = 0.98; 95% CI, 0.32-3.67).
HCV SVR rates were similar before and after removal of the Illinois Medicaid sobriety restriction, regardless of group differences. Results support HCV treatment regardless of documented sobriety to facilitate progress toward HCV elimination.
截至 2018 年 11 月 1 日，伊利诺伊州医疗补助计划将丙型肝炎病毒 (HCV) 药物的覆盖范围限制在已戒酒和戒毒 12 个月以上的患者。尽管临床试验和真实世界数据表明，在有物质使用问题的患者中，持续病毒学应答 (SVR) 率很高，但这一政策限制了 HCV 传播风险较高的患者获得治疗的机会。本研究的目的是比较在伊利诺伊州医疗补助计划取消戒酒限制前后接受治疗的患者的 HCV SVR 率。
我们对 2014 年 1 月 1 日至 2020 年 10 月 21 日在伊利诺伊州一家城市学术医疗中心接受直接作用抗病毒治疗的有医疗补助保险的患者进行了回顾性队列研究。主要终点是 SVR。我们使用 χ 检验或 Fisher 确切检验比较分类变量的组特征，使用 Wilcoxon 秩和检验比较连续变量的组特征。我们使用逻辑回归比较政策变化前后的 SVR 率，同时调整组间差异。
共有 496 名患者（政策变化前 348 名，政策变化后 148 名）开始治疗；排除失访/提前停药，政策变化前 SVR 率为 95.4%（309/324），政策变化后 SVR 率为 97.1%（134/138）。调整历史 HCV 方案的使用和政策变化前组与政策变化后组相比更高的肝硬化率后，SVR 率没有差异（比值比=0.98；95%置信区间，0.32-3.67）。
无论组间差异如何，伊利诺伊州医疗补助计划取消戒酒限制前后，HCV SVR 率相似。结果支持无论是否有记录的戒酒情况，都应进行 HCV 治疗，以促进 HCV 消除的进展。
