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BACKGROUND: In the United States, the prevalence of Hepatitis C Virus (HCV) is greatest in “Baby-Boomers” (those born between 1945 and 1965). Morbidity and mortality associated with HCV infection are more likely to occur as this group ages. All-oral treatments for HCV now exist that can clear HCV infection with few side-effects in over 90% of cases thus mitigating the future burden of HCV infection. However, most people infected with HCV are unaware of their infection and few have successfully completed treatment. As a result, in August of 2012, the Centers for Disease Control and Prevention (CDC) recommended that all persons born between 1945 and 1965 be tested for HCV antibody. This study examines whether or not this national recommendation has made an impact on HCV testing rates in Michigan Baby-Boomers.
METHODS: The Michigan Department of Community Health (MDCH) obtained HCV medical claims data from four large private health insurance companies between January 1st, 2009 and August 31st, 2013 for a retrospective observational cohort study. Rates of HCV antibody claims were calculated by dividing the number of medical claims per month by the number of persons with health insurance coverage per month. The Wilcoxon signed rank test was used to determine if the average rate of HCV testing significantly changed post-recommendation. Segmented linear regression was used to compare the slope of the rate of HCV claims before and after the CDC recommendation.
RESULTS: Approximately 54% of all Michigan Baby-Boomers (1.36 million) were captured by the study. In total there were 120,692 HCV antibody claims during the study period. The rate of HCV antibody claims increased significantly post-CDC recommendation from a median of 144.5 (range: 113.2, 164.6) per 100,000 persons (slope of 0.35, p-value = 0.054, 95%CI: -0.01, 0.70) to 222.9 (range: 180.7, 295.3) per 100,000 persons (slope 10.72, p<0.001, 95% CI 8.9, 12.6) post-recommendation (Student-t p-value <0.0001, r-squared: 0.85).
CONCLUSIONS: The rate of HCV claims increased more than 60% post-CDC recommendation, suggesting that CDC’s HCV birth-cohort recommendation has resulted in an increase in HCV testing in Michigan Baby-Boomers, particularly those covered by private insurance. The rate of testing also increased with time post-recommendation, indicating that HCV-claims were trending up. Still, during the study period, only about 10% of Baby-Boomers would have been tested for HCV, suggesting that the CDC recommendation has not yet reached full penetration.