HEPATITIS C care cascade outcomes may vary substantially depending on whether health systems use laboratory data, pharmacy claims, or both to assess treatment progress, according to a nationwide cohort study of insured U.S. adults.
The analysis included adults aged 18 years and older who underwent hepatitis C virus (HCV) antibody, RNA, or genotype testing between January 30, 2019, and June 30, 2022. Investigators used longitudinal laboratory results, pharmacy claims, and insurance enrollment information to compare outcome measures across the hepatitis C care cascade.
Among 4,515,568 adults with at least one HCV test, 91,491 had evidence of ever having HCV infection. Most individuals in this group, 90.1%, underwent at least one HCV RNA test. Nearly two thirds, 62.0%, had initial HCV infection.
Viral Clearance and Treatment Initiation
Among people with initial infection, 39.9% had viral clearance, 35.7% initiated direct-acting antiviral (DAA) treatment within 360 days, and 26.1% had viral clearance after treatment initiation, used as a proxy for sustained virologic response. Similar care outcome patterns were seen across age groups and payer types, although the magnitude of each measure differed.
The findings highlight a major challenge in hepatitis C care cascade measurement: laboratory-based viral clearance can be limited by missing follow-up RNA testing. Among people with initial infection, 38.3% did not have a subsequent RNA test to assess viral clearance. Of these, 78.4% had no evidence of treatment initiation.
Among 18,246 individuals who initiated treatment, 73.2% had a subsequent HCV RNA-negative result, 3.7% had an RNA-positive result, and 23.2% had no evidence of subsequent testing. Most of those without follow-up testing, 90.8%, received at least 56 days of DAA treatment, suggesting many may have achieved treatment-induced viral clearance despite lacking confirmatory laboratory evidence.
Data Gaps Affect Cure Estimates
The study also found that 21.3% of individuals without recorded treatment initiation later had an RNA-negative result, suggesting spontaneous clearance or treatment not captured in the claims data.
The authors noted that viral clearance after treatment initiation, which requires both laboratory and pharmacy data, is the most rigorous measure and most closely aligns with sustained virologic response. However, this approach may underestimate cure when patients do not return for follow-up RNA testing.
Overall, the findings suggest that better integration of laboratory and pharmacy data, alongside improved follow-up RNA testing, could strengthen monitoring of hepatitis C testing and treatment outcomes. When only one data source is available, viral clearance or treatment initiation may still provide a reasonable substitute for tracking progress toward hepatitis C elimination.
Reference
Symum H et al. Comparison of care cascade outcome measures for hepatitis C among insured US adults. JAMA Netw Open. 2026;9(7).
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