Treatment rates and factors associated with direct‐acting antiviral therapy for insured patients with hepatitis C‐related hepatocellular carcinoma – A real‐world nationwide study

Summary Background Since the inception of the interferon‐free direct‐acting antiviral agents (DAAs) for hepatitis C virus (HCV) infection, guidelines as to who should receive this potentially curative treatment have evolved. Treatment with DAAs is now considered for all patients except for those considered moribund. Aim To determine the DAA treatment rate for patients with HCV‐related hepatocellular carcinoma (HCC). Methods This was a retrospective study from January 2015 to March 2021 of a national sample of privately insured patients with HCV‐related HCC using Optum's Clinformatics® Data Mart (CDM) Database – a large, de‐identified, adjudicated claims database. Results We identified 3922 patients with HCV‐related HCC: 922 (23.5%) received DAA. Compared to untreated patients, DAA‐treated patients were younger (65.2 ± 7.5 vs. 66.4 ± 7.5 years, p < 0.001), more frequently saw a gastroenterology/infectious disease (GI/ID) physician (41.2% vs. 34.2%), and had decompensated cirrhosis (56% vs. 53%, p = 0.001). In multivariable analysis, younger age (HR: 0.98, 95% CI: 0.97–0.99, p < 0.001), GI/ID care (HR: 3.06, 95% CI: 2.13–4.51, p < 0.001), and having cirrhosis (compensated: HR: 1.60, 95% CI: 1.18–2.21, p = 0.003; decompensated: HR: 1.45, 95% CI: 1.07–1.98, p = 0.02) were associated with receiving DAA treatment, but not sex, race, or ethnicity. DAA‐treated patients had significantly higher 5‐year survival than untreated patients (47.2% vs. 35.2%, p < 0.001). Following adjustment for age, sex, race/ethnicity, Charlson Comorbidity Index, and HCC treatment, receiving DAA treatment was associated with lower mortality (aHR: 0.61, 95% CI: 0.53–0.69, p < 0.001). Conclusion DAA treatment remains underutilised in insured patients with HCV‐related HCC; fewer than one in four patients received treatment. Seeing a specialist and having decompensated cirrhosis were predictors for DAA treatment; additional efforts are needed to increase awareness of HCV treatment.