Lack of insurance bars some from hepatitis C treatment

Last Updated: 2015-03-24

By Kathryn Doyle

NEW YORK(Reuters Health) - Survey data from 2001 to 2010 show that lack of insurance kept some people with hepatitis C virus from getting treatment.

Recently, more effective and well-tolerated drugs have been developed to treat hepatitis C, removing many of the discouraging side effects of older drugs. The infection is curable and transmission can be prevented, researchers write in an article published online March 10 in the American Journal of Gastroenterology.

But for the more than three million people in the U.S. who have chronic liver disease from hepatitis C, there are still two important barriers to getting treatment, said lead author Dr. Ivo Ditah from the Mayo Clinic in Rochester, Minnesota.

First, many people with the disease do not know they have it, because they feel no symptoms. Once they've been screened and tested positive, those without health insurance or with poor health insurance likely cannot afford the $250,000 to $350,000 price tag for medications and facility fees, Ditah said.

For the new study, he and his coauthors used National Health and Nutrition Examination Survey data from 2001 to 2010.

Of 38,025 people sampled, 502 tested positive for hepatitis C and 205 were available six months later for follow-up testing. The rest, who tended to be less educated, injecting drugs, or not have health insurance, could not be reached.

Half of those 205 patients said they were not aware of their infection until the surveys were done, and 166 pursued further testing or evaluation, but only 18 received therapy. Lack of health insurance coverage was the only predicting factor for who did not receive treatment.

"I think the message remains very strong that a lack of health insurance is going to be a major stumbling block," Ditah told Reuters Health by phone. "We see a lot of denials from insurance companies not to cover these medications. It's a huge problem."

As newer versions of the best treatments are developed, those in use now will gradually become less expensive, and insurance coverage under the Affordable Care Act has expanded since 2010, Ditah said.

As more people get health insurance, the proportion of people with the infection who cannot be reached will continue to go down, he said.

The Centers for Disease Control and Prevention recommends that all people of the "baby boomer" generation, born between 1945 and 1965, be screened for hepatitis C.

"Those recommendations should be followed. If they are found to have the infection then a good chunk will get treatment," unless they don't have good health insurance, Ditah said.

"It is important to keep in mind that this study was not designed to evaluate provider decision following a positive test result but rather on the action of an asymptomatic individual who screens positive for HCV," the researchers wrote.

The authors reported no external funding or disclosures.

SOURCE: http://bit.ly/1BDtym6

Am J Gastroenterol 2015