Effective treatment for hepatitis C virus (HCV) infection has revolutionized post liver transplant (LTx) care. Administration of direct-acting antiviral agents (DAAs) after HCV+ LTx results in improved allograft and patient survival.

SRTR data were integrated with pharmaceutical claims (2007-16) to identify post LTx HCV treatment (HCV-Rx), insurer, and cost. HCV txp prior to 1/2014, the pre-DAA era (N=21,909), was compared with the post-DAA (N=15,412) era. HCV-Rx patterns were stratified by donor (D) and recipient (R) HCV serostatus and payer: private vs. public.

In the pre-DAA era, 18% of LTx recipients received HCV-Rx within three 3 yrs, with minimal differences by serostatus or payer. In the post-DAA era, D-/R+ LTx, publicly insured patients were 23% more likely to be treated at 2 yrs (private 5.2%, public 6.4%, p<.002). Among D+/R+ LTxs, publicly insured patients were 75% more likely to be treated (private 19.8% public vs. 11.3% private). (P<.0001)

Post-DAA, the cost of HCV-Rx increased markedly. Pre-DAA cost differed minimally by serostatus ($7,748-$9,825). Post-DAA, HCV-Rx treatment of D+/R+ LTx ($120,224) was more costly than D-/R+ ($114,101).

This study is limited as viral load could not be determined for R+ patients and the cost of DAA has declined since 2014.

Post LTx HCV-Rx was reduced in the DAA era among D- LTx, as these patients may have been previously treated. Treatment of HCV D+ LTx (likely viremic) was reduced in recipients with private insurance as these companies have pre-authorization processes which limit access. Further study is needed to assess access to HCV-Rx in viremic LTx recipients.

CITATION INFORMATION: Axelrod D., Schnitzler M., Kasiske B., Hess G., Bloom R., Gordon F., Randall H., Lentine K. Private Insurance is Associated with Reduce Access to HCV Therapy after Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

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