Direct-Acting Antivirals Lowers Mortality Rate of Hepatitis C Infections

Yamini Kalidindi, MHA

Direct-acting antivirals (DAA) could be the answer in treating patients with hepatitis C viral (HCV) infections, regardless of whether they also suffer from cirrhosis.

A team, led by Yamini Kalidindi, MHA, Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, examined the link between direct-acting antiviral medications with mortality among Medicare beneficiaries with hepatitis C viral infections.

Direct-acting antiviral drugs are effective in treating HCV infections. In previous simulations, investigators discovered extended life as a key advantage of this drug class. However, real-world evidence on the link between DAA treatment and reduced mortality is understudied.

In the cohort study, the investigators used Medicare claims data of beneficiaries of 51,478 individuals who sought HCV care for the first time between 2014-2016, following at least a one-year washout period.

They also used Medicare Part D files to identify DAA therapy initiation and completion, as well as death dates, demographic data, and indicators of health risks from the Master Beneficiary Summary Files.

The mean age of the study population was 59.4 years old and 8240 (16.0%) of patients had cirrhosis.

The team considered beneficiaries with hepatitis C who did not initiate DAA if they initiated direct-acting antiviral therapy during the study period. Beneficiaries with HCV infections who did not initiate DAA therapy during the study period were classified as patients without DAA treatment.

The investigators selected patients without DAA treatment using 1-to-1 propensity score matching.

The investigators sought outcomes of the time to death from the index date of seeking hepatitis C care following at least a one-year washout period. They also used Cox proportional hazards regression models with time-varying exposure to compare mortality rates between propensity score-matched cohorts of patients with DAA and patients without DAA treatment.

They also conducted separate analyses for patients with or without cirrhosis and examined heterogeneity in the association between direct-acting antiviral treatment and mortality by sex and dual-eligibility status.

The adjusted hazard ration (AHR) of dying between patients with treatment and those without treatment in the cirrhosis group was 0.51 (95% CI, 0.46-0.57).

The investigators also discovered the association of DAA treatment with mortality did not differ by sex (women vs men: HR, 0.46 [95% CI, 0.38-0.56] vs HR, 0.53 [95% CI, 0.47-0.60]; P = .27) or dual-eligibility status (non—dual-eligible HR, 0.52 [95% CI, 0.43-0.63] vs dual-eligible HR, 0.50 [95% CI, 0.44-0.57]; P = .80) in the cirrhosis group.

The AHR of dying between patients in the treatment group and patients not taking DAA treatment among patients without cirrhosis was 0.54 (95% CI, 0.50-0.58).

The association of DAA treatment with mortality did not differ by sex (women vs men: HR, 0.53; 95% CI, 0.46-0.60 vs HR, 0.55; 95% CI, 0.50-0.60; P = .66) among patients without cirrhosis, but, the survival advantage associated with DAAs for non—dual-eligible beneficiaries was statistically significantly higher than for dual-eligible beneficiaries among patients without cirrhosis (HR, 0.47; 95% CI, 0.41-0.55 vs HR, 0.57; 95% CI, 0.52-0.62; P = .02).

“In this cohort study, DAA treatment appeared to be associated with a decrease in mortality among Medicare beneficiaries with or without cirrhosis,” the authors wrote. “These findings suggest that increasing access to DAA drugs for all patients with HCV infection, regardless of disease progression, could improve population health.”

The study, “Association of Direct-Acting Antiviral Treatment With Mortality Among Medicare Beneficiaries With Hepatitis C,” was published online in Gastroenterology and Hepatology.