Abstract

Background: All-oral interferon-free direct-acting antiviral agents (DAAs) for treatment and cure of hepatitis C virus (HCV) became available in 2013-2014. Our primary objective is to determine the proportion of patients with HCV-related HCC who received DAA after 2014 and factors associated with treatment receipt. We also evaluated DAA treatment impact on the overall survival in this population as a secondary outcome.

Methods: This retrospective study identified patients with HCV-related HCC from 2015-2021 using Optum’s Clinformatics^® Data Mart (CDM) Database – a large, national, de-identified, adjudicated claims database of medically insured patients. Adults with HCV-related HCC and at least 6 months of insurance coverage, but without prior liver transplant, hepatitis B, D or HIV co-infection were included.

Results: We identified and analyzed 3,922 patients with HCV-related HCC. Of these, 922 (23.5%) received DAA. Treatment rates were higher for patients with cirrhosis (both compensated and decompensated), those who received care from gastroenterology (GI) or infectious disease (ID) with or without oncology specialists (Figure 1A). Compared to untreated patients, the DAA-treated group was also younger (65.2±7.5 vs. 66.4±7.5 years, P<0.001). In multivariable logistic regression, younger age (aHR 0.98, 95%CI: 0.97-0.99, P<0.001), being seen by a GI/ID physician (aHR 3.06, 95%CI: 2.13-4.51, P<0.001), having cirrhosis (compensated: aHR 1.60, 95%CI 1.18-2.21; P=0.003; decompensated: aHR 1.45, 95%CI 1.07-1.98, P=0.02) were associated with higher odds of receiving DAA treatment, but not sex or race/ethnicity. DAA treated patients had significantly higher 5-year survival compared to untreated patients (47.2% vs. 35.2%, P<0.001, Figure 1B). Following adjustment for age, sex, race/ethnicity, Charlson Comorbidity Index, HCC treatment, receiving DAA treatment remained significantly associated with lower mortality (aHR:0.61, 95%CI: 0.53-0.69, P<0.001).

Conclusion: Although those who received DAA treatment had a significantly better 5-year survival, DAA treatment remains underutilized even in the sickest of patients with HCV who are insured as less than one in four patients were treated. Seeing GI/ID specialist was associated with 3 times higher odds of receiving DAA therapy in patients with HCV-related HCC, highlighting the needs for a multidisciplinary approach to care for this population.