Utilization of Antiviral Therapy for Patients With Hepatitis B-Related Hepatocellular Carcinoma: A Nationwide Real-World US Study

被引:6
|
作者
Kudaravalli, Sahith [1 ,2 ]
Kam, Leslie Y. [1 ]
Huang, Daniel Q. [4 ,5 ]
Cheung, Ramsey [1 ,6 ]
Nguyen, Mindie H. [1 ,3 ]
机构
[1] Stanford Univ, Med Ctr, Div Gastroenterol & Hepatol, 780Welch Rd,CJ250K, Palo Alto, CA 94304 USA
[2] Duke Univ, Trinity Coll Arts & Sci, Durham, NC USA
[3] Stanford Univ, Sch Med, Dept Epidemiol & Populat Hlth, Palo Alto, CA USA
[4] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
[5] Natl Univ Hlth Syst, Div Gastroenterol & Hepatol, Singapore, Singapore
[6] Vet Affairs Palo Alto Hlth Care Syst, Div Gastroenterol & Hepatol, Palo Alto, CA USA
关键词
Treatment Rate; Liver Cancer; Linkage to Care; Undertreatment; VIRUS INFECTION; TREATMENT ALGORITHM; UNITED-STATES; CURATIVE TREATMENT; MANAGEMENT; SURVIVAL; PREVENTION; RECURRENCE; LAMIVUDINE; ANALOGS;
D O I
10.1016/j.cgh.2023.04.020
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: Although oral antiviral therapy (OAV) is reported to improve outcomes in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), it is underutilized. We determined the rate and factors associated with OAV utilization among patients with HBV-related HCC in a US population with health insurance.METHODS: Patients with HBV-related HCC were identified from the de-identified administrative health claims database for patients with private insurance, Optum Clinformatics (2003-2021).RESULTS: We identified 2129 patients with HBV-related HCC: 71% male, mean age 62.7 - 12.5 years, 40% Asian individuals, 72% with cirrhosis, and 37% received OAV. The treatment rate improved over time (40.5% after 2010 vs 26.3% earlier; P < .001). Significantly lower treatment rates were noted for females, non-Asian patients, noncirrhotic patients, and patients without gastroenterologist/ hepatologist or infectious disease (GI/ID) specialist care (P < .0001). OAV treatment predictors included Asian race and ethnicity (adjusted odds ratio [aOR], 3.6; 95% CI, 2.8-4.5; P < .001), male sex (aOR, 1.6; 95% CI, 1.3-2.0; P < .001), seeing a GI/ID specialist (aOR, 1.5; 95% CI, 1.10-1.99; P = . 0091), having compensated cirrhosis (aOR, 2.2; 95% CI, 1.7-2.8; P < .001), and being treated from 2011 to 2021 (aOR, 2.3; 95% CI, 1.8-3.0; P < .001); being younger (aOR, 0.98; 95% CI, 0.98-0.99; P < . 001) was less likely for treatment. OAV initiated at or before HCC diagnosis was associated independently with improved survival (adjusted hazard ratio, 0.84; 95% CI, 0.72-0.99; P = .037).CONCLUSIONS: Among patients with HBV-related HCC, only 1 in 3 received OAV despite having insurance coverage. Efforts must continue to develop ways to improve HBV OAV treatment, especially among females, non-Asian patients, and patients without cirrhosis or not seen by specialists.
引用
收藏
页码:3305 / 3313.e4
页数:13
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