# Multi-State, Mixed-Methods Evaluation of the Uptake of new Direct Acting Antiviral Regimens for the Treatment of Hepatitus C Virus

> **NIH AHRQ R01** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2020 · $386,804

## Abstract

PROJECT SUMMARY/ABSTRACT
Chronic hepatitis C virus (HCV) affects approximately 3.5 million individuals in the United States. Given the
primary mode of transmission is through infected needles, the ongoing nationwide opioid epidemic will
continue to result in an increase in new cases. Direct-acting antiviral (DAA) medications, introduced in
November 2013 and later, are significantly more effective in treating HCV with fewer side effects but also more
expensive than older interferon-based regimens. Early evidence suggests, however, that these medications
have not been rapidly adopted throughout the healthcare system. Due to high cost, some payers initially
declined coverage or enacted prior authorization (PA) restrictions to limit treatment to patients with advanced
disease or no active substance use disorder (SUD), or required specific prescribing provider specialties. PA
restrictions, however, are not the only barrier to patients receiving treatment. We conducted an analysis of
sofosbuvir and simeprevir uptake, DAA medications introduced in late 2013, in the Massachusetts Medicaid
program, a program that did not restrict reimbursement based on any of these criteria. Despite less restrictive
policies, uptake was low (5%) during the first eight months of their availability. Patient and provider factors
associated with treatment were identified. These results suggest that diffusion of new DAA medications in a
Medicaid population is complex, with patient barriers to care, provider prioritization, provider knowledge, and
organizational factors all potentially playing a role in determining which patients receive treatment.
Using a diffusion of innovation framework, the proposed project will use a mixed methods approach, including
claims analysis and case studies, to expand upon the initial Massachusetts findings to examine uptake of
newer DAA regimens across multiple states. We will perform multi-state Medicaid claims analyses to: examine
trends in uptake of new DAA medications in the Medicaid population (Specific Aim 1); and identify patient,
provider, and contextual factors that predict treatment (Specific Aim 2). In addition, we will conduct key
informant interviews to provide insight into how and why key determinants are associated with higher rates of
eligible patients getting treatment (Specific Aim 3). The central hypothesis underlying our project is that
multiple factors, including, patient, provider and policy-level factors all affect diffusion of these new
medications.
The project will help Medicaid agencies and health care practices translate evidence-based care into clinical
practice. Findings will provide insight as to how providers choose candidates for treatment and will identify
patient or provider groups who may benefit from outreach to improve access. Results may help payers and
providers identify opportunities to enhance care coordination and improve patient outcomes. Finally, the project
will provide an example of uptake of a breakt...

## Key facts

- **NIH application ID:** 9980346
- **Project number:** 5R01HS025717-03
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Karen M Clements
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $386,804
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9980346

## Citation

> US National Institutes of Health, RePORTER application 9980346, Multi-State, Mixed-Methods Evaluation of the Uptake of new Direct Acting Antiviral Regimens for the Treatment of Hepatitus C Virus (5R01HS025717-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9980346. Licensed CC0.

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