(250) Disparities In Direct-Acting Antiviral Agents Uptake And Mortality Among Patients With HCV-Related HCC

Background: Hepatitis C virus (HCV) is the leading cause of hepatocellular carcinoma (HCC) in the United States. Current guidelines recommend the use of direct-acting antivirals (DAA) for patients with HCV-related HCC in stable liver condition or at the early stages of HCC. However, there is limited evidence regarding the association of socioeconomic status (SES) and racial and ethnic disparities in DAA uptake and mortality among patients with HCV-related HCC.

Objectives: To assess disparities in DAA uptake and mortality among Medicare beneficiaries with HCV-related HCC by SES and race and ethnicity.

Methods: This retrospective cohort study included patients aged ≥18 with HCV-related HCC using 2013-2019 Surveillance, Epidemiology, and End Results (SEER) linked Medicare data. Univariate and multivariate logistic regression were employed to assess the odds ratios (OR) of DAA uptake for different SES populations (not having Medicare-Medicaid dual-eligibility [DE] vs. having DE) and race and ethnicity groups (Black, Hispanic, vs. White). Having DE served as the proxy for low SES. To mitigate immortal-time bias in mortality assessment, patients were followed from the first DAA prescription date (i.e., index date) for DAA users or a hypothetical index date, assigned using a prescription-time distribution approach for non-DAA users based on the distribution between HCC diagnosis and the index date in DAA users, until death, disenrollment or the end of the study period (December 31, 2019), whichever occurred first. Following inverse probability weighting, multivariable Cox proportional hazards models were used to compare mortality between the two groups.

Results: We identified 3,977 patients with HCV-related HCC (18.8% Black; 6.6% Hispanic; 62.1% White), with 59.9% as low SES. Compared with patients without DE, patients with low SES were associated with lower DAA uptake (adjusted OR [aOR] 0.878. 95% CI 0.732-1.052) and higher risk of death (adjusted hazard ratio [aHR] 1.313, 95% CI 1.212-1.423). In racial and ethnicity comparisons, Black patients had higher DAA uptake (aOR 1.057, 95% CI 0.842-1.327) and higher risk of death (aHR 1.025, 95% CI 0.929-1.131), while Hispanic patients had lower DAA uptake (aOR 0.874, 95% CI 0.611-1.251) and lower risk of death (aHR 0.894, 95% CI 0.767-1.043) compared with White patients, although all results were statistically insignificant.

Conclusions: Our finding suggests that race and ethnicity and disparities in SES did not significantly impact DAA uptake. However, patients with low SES were associated with higher risk of death. Future studies investigating DAA uptake patterns and long-term effects of DAAs on mortality within this population are warranted.