De-identified data came from healthverity, a nationwide administrative claims and encounters database that contains person-level longitudinal enrollment records, lab test results, and prescription information.§ The retrospective cohort in this study included approximately 2 million people from all 50 states and the district of columbia enrolled in private insurance, medicare advantage, or medicaid managed care plans who had been tested for hcv infection and had ≥1 day of enrollment in private insurance , medicaid, or medicare coverage (supplementary chart, https://stacks.cdc.gov/view/cdc/119619). healthverity claims capture complete health care usage and enrollment records at outpatient physician practices, diagnostic centers and pharmacies. Enrollment, lab test, and pharmacy claims databases were linked using HealthVerity’s proprietary person-level deterministic matching algorithm.
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an analytical cohort of patients with hepatitis c (those who received at least one positive result in the hcv RNA test between January 30, 2019 and October 31, 2020) was created selecting between patients from 18 to 69 years of age who received any hcv test. Test. The earliest date of receipt of a positive HCV RNA test result that occurred within the selected time frame was defined as the HCV RNA positive index test date. Eligible persons had continuous enrollment in medical and pharmacy plans for ≥ 60 days before and ≥ 360 days after the date of the positive RNA index test, and had no evidence of DAA treatment during the 60 days prior to the date of the positive RNA index test. of the hcv RNA index test. DAA treatment initiation was defined as receipt of any prescription using the National Drug Codes definition from the Food and Drug Administration and the American Association for the Study of Liver Diseases/Infectious Diseases Society of America.¶ for individuals With a DAA treatment pharmacy claim, the first DAA prescription date was assigned as the DAA treatment index date. The interval from the positive index RNA test result to the date of DAA treatment for the treatment cohort was defined as the difference between the date of the positive HCV RNA index test and the fill date of the DAA index prescription. The prevalence of daa treatment initiation was calculated as the percentage of eligible patients who started daa treatment within 360 days of the date of the positive rna index test. The primary outcome for analysis was the receipt of a DAA pharmacy claim during the 360-day follow-up period. covariates included gender (ie, female or male), age group (ie, 18-29, 30-39, 40-49, 50-59, and 60-69 years), race (ie, white, black , Asian, or other race) and type of insurance (ie, private, medicare managed care, and medicare advantage). ethnic origin was only available for 39% of people and was not included in the primary analyses. Medicaid treatment restrictions were defined as state Medicaid programs that impose any of three restrictions prior to authorization of DAA treatment: presence of liver fibrosis that meets the criteria for fibrosis stage, mandatory sobriety, or abstinence from alcohol or drugs (≥1 month), or prescription requirement by or in consultation with a specialist. State level Medicaid treatment restrictions data was obtained from hepvu,** an online platform used to visualize data and disseminate information about the us. uu. hepatitis epidemic. State-level restriction was defined as the presence of one or more restrictions at the time of the patient’s index HCV RNA positive test date. We excluded data from this analysis for people who tested positive for HCV RNA but did not have gender, age, or residency status (0.4%).
daa treatment initiation was assessed using 95% cis and point estimates; A Wald chi-square test of independence was used to compare baseline characteristics by treatment status. Multivariate logistic regression models were used to quantify the association between covariates and HCV DAA treatment, adjusting for gender, age group, race, insurance type, and Medicaid treatment restriction status; aor and 95% cis were calculated with p<0.05 considered statistically significant. Sensitivity analyzes were performed to assess the potential effects of missing ethnic data, alternate codes for race, and the impact of state Medicaid treatment restrictions. Analyzes were performed using Azure Databricks (web version; Databricks) and RStudio (version 4.1; RStudio). This activity was reviewed by CDC and conducted in accordance with applicable federal law and CDC policy.††