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( Darshan Mehta ),( Jeffrey Mccombs ),( Yuri Sanchez Gonzalez ),( Steven Marx ),( Sammy Saab ),( Yongkyun Won ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The World Health Organization [WHO] has set a goal of having 90% of the world’s population screened for chronic hepatitis C (HCV) infection by 2030. Starting from 2014 in the United States (US) 5 states (NY, CA, CT, MA, CO) implemented new HCV screening policies. This study assesses the effectiveness of these screening laws and projects states’ progress toward the WHO target. Methods: Claims data for 2010-2016 from Optum Clinformatics ® Data Mart, a de-identified claims database from the US were analyzed. HCV screening was identified by paid claims for CPT codes 86803, 86804, or G0742. Logistic regression models of the likelihood of a patient being screened were estimated, controlling for patient demographic and clinical characteristics. Three time periods [2010; 2011-13 and 2014-16] were used to measure the effect on screening of the availability of the newer curative agents. Variables identifying states with screening policies were entered as interaction terms with the post-2014 time period to test if new screening policies enhanced screening rates, independent of the availability effect of the newer agents. Further, the proportion of the population screened in each state was extrapolated to 2050 using each state’s 2014-16 screening rates applied to an assumed baseline diagnosis rate of 50%. Results: Relative to the annual screening rate in 2010, annual screening rates were increased by 19.9% post 2014. In the states that passed screening laws, the annual post 2014 screening rates were increased by an additional 6.4%. Among the states that passed screening laws, MA and CT increased annual screening rates but policies in NY, CA and CO had no significant effect. Other factors that increased the likelihood of a patient being screened were female gender, Medicare enrollment and presence of comorbidities like chronic kidney disease, mixed cryoglobulinemia, fatigue and coinfection with HIV and/ or HBV. Projections of screening rates suggest that NY and 4 other states without screening laws were on track to reach the WHO target by 2030 with 8 additional states attaining WHO target by 2040. 29 states would not attain this target by 2050. Conclusions: The availability of curative therapies has increased the likelihood of screening for HCV. While current efforts to increase annual HCV screening have had positive impact, over 90% of states in the US are still not on track to reach WHO target by 2030.
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