studies

472A AASLD ABSTRACTS HEPATOLOGY, October, 2015
alcohol-attributable liver disease in USA is unknown. Therefore,
the aim of this study is to investigate the epidemiological
trends of alcohol liver disease in USA. Methods: The UNOS
liver transplant registry and National Vital Statistics Systems
(NVSS) was assessed for individuals with alcohol liver disease
(ALD). Using the UNOS database, we identified all adult (>
18 years) candidates during the 10-year study period (2004
– 2013) who were (i) added to liver transplant waiting list
and (ii) candidates who received liver transplant (LT). Using
the NVSS database, we identified all adults (> 18 years) with
a cause of death attributed to alcohol liver disease using the
ICD code (K70). Data extracted from both (UNOS and NVSS)
databases included patient demographics (i.e. age, gender
and ethnicity), and from the UNOS database (MELD score and
UNOS regions). The age groups in the UNOS database are
categorized as (i) 18 – 34 years (ii) 35 – 49 years (iii) 50 – 64
years and (iv) 65 + years and in the NVSS database (i) 18 –
24 years (ii) 25 – 44 years (iii) 45 – 54 (iii) 55 – 64 years
and (iv) 65 + years. Results: During the study period 15,608
candidates with ALD were added to the waiting list (WL) and
6,502 received liver transplant. In the NVSS mortality dataset,
there were 150,613 with a primary cause of death attributed
to ALD during the study period. In the latter dataset, among all
individuals with a diagnosis of cirrhosis (ALD and non-ALD),
there was a significant increase in mortality for the proportion
with ALD from 46% (2004) to 50% (2013). However, age-specific
analysis showed that the increase in mortality rate was
only significant in the age group < 55 years. Regarding transplantation
trends there was an increase in both the addition of
candidates with ALD to the WL and increase in liver transplant
for candidates with ALD, but only in those in the age group
35 – 49 years. In this age group, there was an increase in WL
from 14.2% (2004) to 28.4% (2013) and increase in LT from
11% (2004) to 25.3% (2013). There was no change in either
WLR or LT in the other age groups. Conclusion: The burden of
ALD in USA in the last decade is increasing. ALD is becoming
a major public health crisis in the younger age group, and it is
now the most common indication for both liver transplant and
wait list addition in the age group 35 -49 years.
Disclosures:
Edson S. Franco - Grant/Research Support: Biospheres Medical
Angel Alsina - Speaking and Teaching: Bayer, Novartis
The following authors have nothing to disclose: Nyingi M. Kemmer, Thure Caire
527
Evaluation of DAA (direct-acting antiviral) access across
the US: the interplay between Hepatitis C (HCV) patient
and insurance type
Jason Katz, Samantha Fernando, Antoinette Wilson, James
Deemer, Marijke Frantsen; Ipsos Healthcare, New York, NY
BACKGROUND In the last 18 months, highly effective DAAs
have become available for HCV treatment, but the cost of these
drugs has made access challenging. In this paper we examine
treatment decision-making across payers by patient type.
METHOD Ipsos Healthcare’s HCV Therapy Monitor, running
since 2005 in the USA, reports on >150 physicians per quarter,
previously annually, across the USA. Physicians provide
patient demographic, disease and treatment data on treated
and untreated HCV patients seen within each study period.
Here, new DAAs include all sofosbuvir- and dasabuvir-containing
regimens. RESULTS Following the launch of sofosbuvir
in December ‘13, HCV treatment rates increased from 12%
to 23% from Q1’14 to Q1‘15. During Q1‘15, rates of treatment
with new DAAs differed across insurance types; 25%
of all privately insured patients were on new DAA regimens,
versus 21% and 16% of Medicare and Medicaid patients,
respectively. All untreated patients who had payer restrictions
as a treatment barrier, regardless of payer type, rose from
5% to 22% from Q1’14 to Q1’15. In Q1’15, physicians’ top
barriers to prescribing new DAAs were restricted to certain
patient type (24%) and insurance coverage (19%). Publically
insured patients are more likely to have advanced fibrosis
(F3-F4) (46%) than privately insured patients (29%). Amongst
more advanced patients across all payer types, F3 patients
rather than F4 patients are most likely to be treated with a
new DAA; this is also observed throughout ‘14. This trend is
more pronounced at the Medicaid group where half of currently
untreated F4 patients are substance abusers and 92%
suffer from another condition. Of the whole Q1’15 untreated
population, 33% are substance abusers and 77% suffer from
another concomitant disorder. The population treated with a
new DAA includes 16% substance abusers and 66% suffering
from comorbidity. CONCLUSION Treatment of HCV patients
with a new DAA is heavily influenced by fibrosis, payer type,
comorbidities, and substance abuse status. Publically insured
patients are more likely to have advanced fibrosis than the
privately insured but the latter are more likely to be on a new
DAA. Untreated patients are more likely to be substance abusers
and suffer from comorbidities. These results reflect the adjudications
made by US payers, many deciding to treat patients
with advanced fibrosis who are free of conditions that could
mitigate treatment outcomes. This also highlights that a large
proportion of the population suffering from advanced fibrosis
currently face access barriers to new DAAs because of their
patient profile and insurance coverage.
Disclosures:
Jason Katz - Consulting: Abbvie, Gilead, Bristol Myers Squibb
The following authors have nothing to disclose: Samantha Fernando, Antoinette
Wilson, James Deemer, Marijke Frantsen
528
Geriatrics and cirrhosis: changing epidemiology of
chronic liver disease among the elderly, 2004-2013
Michael Hagan, Maria A. Kouznetsova, Sumeet K. Asrani; Baylor
University Medical Center, Dallas, TX
Introduction Chronic liver disease (CLD) morbidity has
increased over the last decade, with a marked increase in
admissions among the elderly. Methods: We examined all CLD
related encounters (2004-13) in the elderly (>65 years) in the
Baylor Health Care System serving Dallas-Fort Worth in rural,
urban and community settings (8 hospitals, catchment 7 million,
>130,000 annual admissions). Results: There were 26,816
CLD related admissions (2004-2013); 23% of the admissions
were in the elderly. Elderly patients had a higher prevalence of
NAFLD/cryptogenic cirrhosis (44%) vs. 31% (45-54) and 41%
(55-64) and primary liver malignancy (6.6%) vs. 3.3% (45-54)
and 4.5% (55-64). Comorbidities were high: CAD (25%), CHF
(22%), COPD (13%), DM (44%). Infection was higher in the
elderly (33%) vs. 26% (45-54) and 25% (55-64). Disposition
to home was lowest (51%) and inpatient mortality/hospice was
highest in the elderly (20%) vs. 11% (45-54) and 14% (55-64).
From 2004-05 to 2012-13, the largest increase in admissions
were ages 55-64 (126% increase) and 65+ (83% increase).
In the elderly, admissions increased three fold (5.5 to 14.4%).
NAFLD/cryptogenic liver disease increased (32% to 50%) and
viral hepatitis decreased (17% to 9.5%). Comorbid conditions
increased (p