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Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
Background: Testing and linkage to care is a secondary prevention measure to reduce hepatitis B virus (HBV) infection and associated morbidity and mortality from liver disease and liver cancer. Although routine testing among risk-groups is covered under health plans and it is expected that everyone with chronic hepatitis B is linked to care and considered for treatment, the percentage of HBV–infected adults in which linkage to care and treatment occurs is unclear.
Methods: We obtained demographic, enrollment, and insurance claims data from Truven Health’s MarketscanTM commercial insurance claims database. We included all adults aged ≥18 years with employer health plans. Inclusion criteria required continuous enrollment 6 months before and 12 months after the first diagnosis claim for chronic hepatitis B between the dates of 1/1/2008 and 12/31/2015. We defined chronic hepatitis B as ≥2 chronic hepatitis B ICD-9-CM/ICD-10-CM diagnosis codes entered on service dates at least 2 weeks apart.
Linkage to hepatitis B–directed care was defined as an alanine aminotranferase (ALT) test in conjunction with (either HBV DNA or hepatitis B e antigen tests) as defined by relevant CPT codes at least 12 months after chronic hepatitis B diagnosis. We also assessed antiviral treatment with a claim for any of the following antivirals: tenofovir, telbivudine, lamivudine, entecavir, adefovir, or pegylated interferon alpha-2a after diagnosis.
Results: We found 14,752 individuals who met the inclusion criteria for our chronic hepatitis B case definition. Among these cases, 8,175 (55%) were males and the median age was 45 years. There were 5,315 (36%) individuals with linkage to hepatitis B directed care; specifically, 6,975 (47%) were tested for ALT, 8,986 (61%) HBV DNA, and 4,881 (33%) HBeAg.
Of the 14,752 individuals with chronic hepatitis B, 2,681 (18%) had HBV antiviral claims following diagnosis. Of the 2,681 with HBV antiviral treatment claims, 1,239 (46%) had tenofovir, 1,040 (39%) had entecavir, 192 (7%) had adefovir, 110 (4%) had lamivudine, 78 (3%) had pegylated interferon alpha-2a, and 22 (0.8%) had telbivudine.
Conclusion: In this cohort of commercially insured chronic HBV infected adults, we identified substantial gaps in linkage to hepatitis B directed care. Increased efforts are needed to ensure that all individuals with chronic hepatitis B are linked to appropriate care and receive antiviral treatment when appropriate.