Population-based hepatitis C surveillance and treatment in a national managed care organization.

OBJECTIVES: To use a national population-based automated claims database to study the testing rate, prevalence, and prescribing patterns for chronic hepatitis C. STUDY DESIGN: A retrospective descriptive study that analyzes medical and pharmacy automated claims from affiliated health plans in 4 regions of the United States. METHODS: Data were collected from 11 UnitedHealth Group-affiliated health plans (3.9 million members) from January 1, 1997, to December 31, 1999. Medical claims were used to identify persons tested for hepatitis C virus (HCV). Persons with chronic HCV were identified through medical and pharmacy claims. Patterns of drug use and treatment were analyzed, including prescribing physician specialty and proportion of patients receiving baseline and follow-up testing. RESULTS: Of 27,871 members tested for HCV (0.7%), 1869 (6.7%) were diagnosed as having chronic HCV. Tested patients were more likely to be female (odds ratio [OR], 1.1) and older (> or = 25 years; OR, 4.1). Of 3259 patients with HCV, most were male (OR, 1.8) and older (> or = 25 years; OR, 32.0). Of these patients, 33.6% (n = 670) of men and 25.2% (n = 319) of women received treatment. Combination therapy users were more likely to undergo baseline (OR, 4.8) and follow-up (OR, 6.2) testing compared with interferon alfa monotherapy users. CONCLUSIONS: Of the total population, 0.7% were tested for HCV, of whom 6.7% were diagnosed as having chronic HCV. Although women were more likely to undergo testing, prevalence and therapy rates for chronic HCV were higher in men. Most patients did not receive recommended baseline and follow-up testing, and the approximate 30% therapy rate suggested that many patients with HCV remain untreated.

Duke Scholars

Author Keyur Patel Medicine, Gastroenterology