Changing Demographics Among Populations Prescribed HCV Treatment, 2013-2017

OBJECTIVES: We analyzed the demographics and disease characteristics of patients prescribed treatment for chronic hepatitis C virus (HCV) infection from 2013 through 2017, a time frame that encompasses the expansion of available direct-acting antiviral inhibitors. STUDY DESIGN: Retrospective analysis. METHODS: Using a proprietary disease-management program, data for 19,944 patients receiving HCV treatment were collected from providers and specialty pharmacies. Six-month time periods accounting for introductions of novel treatments were established as follows: December 2013 to May 2014 [n = 1438], simeprevir and sofosbuvir; October 2014 to March 2015 [n = 2242], ledipasvir/sofosbuvir and ombitasvir/paritaprevir/ritonavir plus dasabuvir; October 2015 to March 2016 [n = 5514], daclatasvir; July 2016 to December 2016 [n = 5562], elbasvir/grazoprevir and sofosbuvirivelpatasvir; and July 2017 to December 2017 [n = 5188], sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir. Changes over time were evaluate for statistical significance. RESULTS: In the 2013-2014 time period, 44% of patients receiving prescriptions for HCV treatment were treatment-experienced and 45% had cirrhosis. By 2017, only 14% were treatment-experienced (P <.001) and 21% had cirrhosis (P <.001). The percentage of patients with HCV genotype 1 increased from 69% to 87% from 2013-2014 to 2014-2015 (P <.001) but subsequently decreased to 74% in 2017 (P <.001). The percentage of patients receiving HCV prescriptions in an academic setting declined from 61% in 2013-2014 to 13% in 2017 (P <.001). CONCLUSIONS: In the United States since the introduction of interferon-free HCV regimens, the patient population prescribed treatment has changed, becoming predominantly treatment-naive, without cirrhosis, and treated in nonacademic centers.