PMID: 29851444Jun 1, 2018Paper

Increasing hepatitis C screening in a large integrated health system: science and policy in concert

The American Journal of Managed Care
Carla V RodriguezMichael Horberg

Abstract

To evaluate whether the updated 2013 US Preventive Services Task Force (USPSTF) hepatitis C virus (HCV) screening recommendations, related Affordable Care Act provisions, and the impending availability of efficacious therapies were associated with increased screening in an integrated health system. We analyzed 665,339 records of adult patients visiting Kaiser Permanente Mid-Atlantic States clinics from 2003 to 2014. We used Cox proportional hazards to estimate time to HCV screening and confirmation after June 1, 2013, compared with prior. HCV screening steadily increased over time, but it jumped 29% (P <.01) from 2013 to 2014 versus 4% (P <.01) from 2012 to 2013. The adjusted hazard ratio for HCV screening since June 2013 was 2.40 (95% CI, 2.34-2.47) times higher than it was pre-intervention among the birth cohort (those born 1945-1965) and 2.00 (95% CI, 1.96-2.04) times higher in those born in other years, representing a 1.20-fold (95% CI, 1.17-1.24) greater increase in the screening rate among the birth cohort. We also identified variability in those thought to be at higher risk of HCV infection. HCV screening has been increasing in our healthcare system, more so since June 2013 and among the birth cohort. The availability of...Continue Reading

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