Characteristics associated with time‐to‐treatment initiation for chronic Hepatitis C with new direct acting antivirals

Background Interferon‐free direct‐acting antivirals (DAAs) were introduced in 2013 and have transformed the therapeutic landscape for chronic Hepatitis C (HCV). Although treatment is recommended for almost all persons infected with HCV, clinical and psychosocial factors may affect treatment initiation. Methods We conducted an observational cohort study of Kaiser Permanente Mid‐Atlantic States members with prevalent or incident HCV infection identified from November 2013 through May 2016 to identify predictors of DAA initiation. We used Cox regression with time‐dependent covariates to compare time to treatment by clinical, demographic and societal factors. Results Of 2962 patients eligible for DAA therapy, 33% (n = 980) initiated treatment over the study period. The majority of patients (97%) were persistent with therapy and most (95%) tested for sustained virologic response (SVR) achieved cure. We found no effect of race, insurance type or fibrosis stage on treatment initiation. We observed that patients aged 41‐60 years (aHR: 2.014, 95% CI: 1.12, 3.60) and 61‐80 years (aHR: 2.08, 95% CI: 1.15‐3.75) had higher treatment rates compared to younger patients. Incident cases were more likely to be treated than prevalent cases (aHR: 3.05, 95% CI: 2.40‐3.89). Patients with a history of substance use disorder (SUD) were less likely (aHR: 0.805, 95% CI: 0.680, 0.953) to be treated. Conclusions In the first 3 years of DAA availability, one‐third of patients with HCV initiated therapy, and almost all were persistent and achieved cure. While curative, DAAs remain highly priced. Triaging for non‐clinical reasons or perceptions about patients will stall our ability to eradicate HCV.