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Monitoring the Hepatitis C Care Cascade Using Administrative Claims Data
Cheryl Isenhour, DVM, MPH; Susan Hariri, PhD; and Claudia Vellozzi, MD, MPH
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Monitoring the Hepatitis C Care Cascade Using Administrative Claims Data

Cheryl Isenhour, DVM, MPH; Susan Hariri, PhD; and Claudia Vellozzi, MD, MPH
Development, validation, and application of hepatitis C case-finding algorithms to describe the care cascade among a commercially insured population in the United States.
Limitations

Our study is subject to certain limitations. First, these analyses were conducted among a subset of commercially insured enrollees and are not generalizable to all HCV-infected individuals in the United States. Second, it is possible that enrollees included in the validation study were misclassified by HCV RNA test result if enrollees we classified as always negative had a positive test result prior to January 1, 2011. Third, because we selected algorithms based on PPV to maximize accuracy, our algorithms may not be suitable for other evaluations, such as estimating HCV prevalence.

Finally, we were not able to describe the care cascade for HCV-infected enrollees in MarketScan who were not identified by the algorithms. However, among 1098 enrollees testing positive for HCV RNA identified in the MarketScan laboratory test results subset, during the same time period, we found that 79% were engaged in HCV-specific care and just 30% initiated treatment (data not shown). It is not surprising that fewer enrollees in the RNA-positive subset were engaged and subsequently treated, as our algorithms selected individuals based on chronic HCV diagnosis codes documented at healthcare encounters; individuals not having chronic HCV-related encounters will not be selected. It is possible that we have selected enrollees who were already exhibiting signs of advanced liver disease and prioritized for treatment. Additional analyses are under way to further examine the differences between the cascades developed using the validated algorithms and the subset of enrollees with laboratory test results.

CONCLUSIONS

We have successfully validated 2 algorithms to identify cases of chronic HCV in claims data and described the HCV care cascade among those identified by the algorithms. In addition to utilizing these algorithms to identify cases of HCV in other sources of claims data, analyses are under way to identify predictors of progression along the cascade. Although 95% of enrollees chronically infected with HCV were engaged in HCV care and 49% initiated HCV treatment, our findings indicate that commercially insured enrollees in care may still find it challenging to access HCV treatment. Additionally, a previous analysis of trends in HCV antibody testing among MarketScan enrollees demonstrated that just 3% of individuals born from 1945 to 1965 and 2% of persons born in other years received an antibody test in 2014,28 highlighting a clear need for improved uptake of national testing recommendations.6 It will be important to continue to monitor the HCV care cascade over time to ensure that all individuals living with HCV receive recommended care and treatment. 

Acknowledgments

The authors would like to acknowledge the contributions of Lauren Canary, Liesl Hagan, Dr Aaron Harris, and Dr Alexander Millman, who assisted with the creation of an inclusive list of ways insured enrollees could be engaged in HCV-specific care.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Author Affiliations: Partnerships and Evaluation Branch, Division of Health Informatics and Surveillance (CI), and Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases (SH), and Prevention Branch, Division of Viral Hepatitis (CV), CDC, Atlanta, GA.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (CI, SH, CV); analysis and interpretation of data (CI, SH, CV); drafting of the manuscript (CI, CV); critical revision of the manuscript for important intellectual content (CI, SH, CV); statistical analysis (CI); and supervision (SH, CV).

Address Correspondence to: Cheryl Isenhour, DVM, MPH, Mailstop E-91, Division of Health Informatics and Surveillance, CDC, 1600 Clifton Rd, Atlanta, GA 30329. Email: xwz0@cdc.gov.
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