(291) Postpartum Treatment Initiation among Pregnancies Diagnosed with Hepatitis C between 2016-2021 using the United States Commercial Claims Data

Background: The U.S. Centers for Disease Control and Prevention updated recommendations in 2020 to implement universal screening for hepatitis C virus (HCV) infection during pregnancy. Recent evidence shows a steady increase in the proportion of pregnancies tested but whether this has increased postpartum treatment in this population is unknown.

Objectives: This study aimed to estimate the percentage of pregnant persons diagnosed with HCV infection initiating treatment with direct-acting antivirals (DAAs) in the postpartum period.

Methods: We used a retrospective cohort design to estimate the incidence of DAA initiation among pregnancies identified in the Merative® MarketScan Commercial Claims database from 2016-2021. We included persons aged 12-55 years newly diagnosed with HCV infection during pregnancy with continuous health plan enrollment of greater than 6 months before the last menstrual period (LMP) through 12 months after the end of pregnancy. Pregnancies with a history of liver cirrhosis, hepatocellular carcinoma, and liver transplant were excluded, as were pregnancies with HCV diagnosis or DAA use before LMP. Pregnancies had to have at least 2 HCV diagnoses represented by ICD-10 codes on separate dates. Initiation of DAAs was ascertained using pharmacy dispensing claims during pregnancy up to one year after the end of pregnancy. Factors considered as possible determinants of treatment initiation included HCV infection risk factors, patient demographics, calendar year, and regional characteristics. Additionally, we determined treatment initiation in a sub-cohort of pregnancies with an HCV RNA test after pregnancy measured using Current Procedural Terminology codes.

Results: Out of the 207,366 pregnancies that were screened for HCV infection, 147 had ≥2 diagnoses and ≥1-year postpartum follow-up. Of these, 22 (15%) received DAAs with two initiating treatment during pregnancy. Positive determinants of DAA initiation were non-live pregnancy outcomes (6/22, 27% with DAA) and hepatitis B virus co-infection (3/11, 27%), although sample size limited inferences. Age, calendar year, and regional health care quality or HCV incidence did not appear to correlate with DAA use. Among the 35 pregnancies that received an RNA test after pregnancy ended, 19 (54%) initiated DAAs.

Conclusions: DAA initiation during the postpartum period among persons diagnosed with HCV infection during pregnancy is low. Although breastfeeding status might explain findings in part, low treatment rates among postpartum individuals with pregnancy loss support overall conclusions. Reasons for low uptake deserve further exploration.