Less Restrictive Medicaid Policies for Direct-Acting Antiviral Access Are Associated With Greater Declines in Hepatocellular Carcinoma Deaths.

BACKGROUND

In the United States (US), chronic hepatitis C virus (HCV) is the leading cause of hepatocellular carcinoma (HCC). Direct-acting antivirals (DAAs) cure HCV and reduce HCC risk, but Medicaid DAA coverage varies across states.

AIM: We assessed whether Medicaid DAA access was associated with trends in HCC-related deaths.

METHODS

We analyzed CDC WONDER death certificate data (1999-2023) to assess HCC-related mortality. US states were grouped based on Medicaid DAA prior authorization restrictions using the Hepatitis C: State of Medicaid Access scoring system: A+/A (n = 28), B (n = 11), and C/D (n = 12). We used NCI Joinpoint software to calculate the annual percentage change (APC) and average annual percent change (AAPC) in age-adjusted death rate. State-specific HCC crude death rates were analyzed before and after 2014, alongside changes in Medicaid DAA policies from 2014 to 2024.

RESULTS

Before 2017, HCC-related death rates were positive in group A + /A (APC 2.01, 1999-2017), group B (APC 3.40, 1999-2009), and group C/D (APC 2.04, 1999-2023). Age-adjusted death rates became negative in group A+/A states (APC -0.19, 2017-2023), while death rates continued to be positive for group B states (APC 1.49, 2009-2023) and group C/D states (APC 2.04, 2017-2023). The AAPC (1999-2023) was lowest in group A + /A (1.46), followed by group B (2.28) and C/D (2.04). From 2014 to 2024 accessibility to DAAs improved.

CONCLUSION

Increased DAA access was associated with reduced HCC-related death rates. Improved HCV treatment could contribute to decreased HCC incidence and recurrence, enhance linkage to subspecialty care, and prevent liver-related decompensation.