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INTRODUCTION RESULTS PURPOSE METHODS CONCLUSION LIMITATIONS HCV SCREENING OF “BABY BOOMERS” INCREASED SIGNIFICANTLY FOLLOWING 2012 CDC CALL TO ACTION BUT SCREENING RATE FELL IN NON-BABY BOOMERS: RESULTS OF A NATIONWIDE LAB TEST DATABASE ANALYSIS Carol Smyth 1 , Jason Bhan 1 , Tatiana Sorokina 1 , Ajitpal Singh Dhaliwal 2 , Nancy Reau 3 , 1 Medivo Inc., New York, NY; 2 St. Luke’s-Roosevelt Hospital, New York, NY; 3 University of Chicago, Chicago, IL. ABSTRACT PURPOSE: In August 2012, the Centers for Disease Control and Prevention (CDC) called for all Americans in the “Baby Boomer” generation (born 1945 - 1965) to have one-time screening for hepatitis C (HCV). To assess the impact of the CDC call on screening rates, we compared HCV screening rates between the Baby Boomer and the non-Baby Boomer cohorts in the year before vs. the year after the CDC call to action, and also projected screening rates in the 2nd year following the CDC call. METHODS: Using data from the nationwide Medivo Lab Exchange Database (Medivo Inc., NY, NY), we analyzed 106,272 practices that screened 5,549,760 adults for HCV between August 2011 and April 2014; 1,523,228 (27.4%) were Baby Boomers and 4,026,532 (72.6%) were non-Baby Boomers. We analyzed rates of HCV screening in the year preceding the CDC call to action (August 2011 – July 2012), in the year following the CDC call (August 2012 – July 2013), and projected rates in the 2nd year after the CDC call (data from August 2013 - April 2014, projected to July 2014). 2-way ANOVA was utilized to assess the effect of the CDC call to action on HCV screening rates between the 2 groups (Baby Boomers vs. non-Baby Boomers). RESULTS: Overall, the average number of patients screened per practice fell in the year following the CDC call (8.14 vs. 7.77; 8.25 projected for the second year following). Turning to the birth cohorts, our analysis shows that in the year following the CDC call to action, there was a 10% increase in the average number of Baby Boomers screened for HCV/practice (4.17 vs. 4.58, p<0.001) and a 10% decrease in the average number of non-Baby Boomers screened/practice (12.11 vs. 10.97, p<0.001). During the second year following the CDC call to action, projections indicate a significant increase in screening in both cohorts compared to the screening rates in the year before the CDC call to action: a 25% increase in the average number of Baby Boomers screened and a 3% increase in the average number of non-Baby Boomers screened (4.17 vs. 5.23 in the Baby Boomers and 12.11 vs. 12.47 in the non-Baby Boomers, p<0.001). CONCLUSIONS: In the year following the CDC call, screening rates rose significantly (10%) in the Baby Boomer cohort, but also decreased significantly (10%) in the non-Baby Boomer cohort. Further study is needed to see if these changes were due to healthcare professionals changing their criteria for screening from risk factors to birth cohort. It is of interest that projected rates suggest that screening rates in both cohorts will increase significantly in the second year following the CDC call to action, which may indicate further changes in screening criteria. ● People born between 1945-1965 (the “Baby Boomer” generation) account for 75% of chronic hepatitis C virus (HCV) infections in the US. 1 ● The Centers for Disease Control and Prevention (CDC) estimates that about 1 in 30 people in this birth cohort have HCV, however most of those infected are unaware that they have the virus. 1 Deaths from HCV-related illnesses have been rising over the last decade, and are projected to continue to rise. 1 ● In August 2012, the CDC issued a call to action, recommending that all individuals born between 1945 and 1965 receive a one-time screening for HCV without prior ascertainment of HCV risk. 1 ● The Medivo Lab Value Exchange Database™ (LVX™) is the largest aggregation of standardized and anonymized lab test results. Insights on clinician practices and testing trends are available, based on this nationwide database. 2 ● To assess the impact of the CDC call on HCV screening rates, we compared the Baby Boomer screening rates vs. rates in the non-Baby Boomer cohorts in the year before vs. the year after the CDC call to action, and also projected screening rates in the 2nd year following the CDC call to action. ● Overall, the average number of patients screened per practice fell in the year following the CDC call (8.14 vs. 7.77; 8.25 projected for the second year following). ● Turning to the birth cohorts, our analysis shows that in the year following the CDC call to action, there was a 10% increase in the average number of Baby Boomers screened for HCV/practice (4.17 vs. 4.58, p<0.001) and a 10% decrease in the average number of non-Baby Boomers screened/practice (12.11 vs. 10.97, p<0.001). (Figure 1) ● During the second year following the CDC call to action, projections indicate a significant increase in screening in both cohorts compared to the screening rates in the year before the CDC call to action: a 25% increase in the average number of Baby Boomers screened and a 3% increase in the average number of non-Baby Boomers screened (4.17 vs. 5.23 in the Baby Boomers and 12.11 vs. 12.47 in the non-Baby Boomers, p<0.001) (Figure 2). ● At the time of analysis, the Medivo Lab Value Exchange Database™ (LVX™) included over 200,000 practice locations and 27 million patients. ● Using data from the Medivo LVX, we analyzed 106,272 practices that screened adult patients for HCV (N = 5,549,760) between August 2011 and April 2014; 1,523,228 (27.4%) were Baby Boomers and 4,026,532 (72.6%) were non-Baby Boomers. ● We analyzed rates of HCV screening in the year preceding the CDC call to action (August 2011 – July 2012), in the year following the CDC call (August 2012 – July 2013), and projected rates in the second year after the CDC call (data from August 2013 - April 2014, projected to July 2014). ● We used 2-way ANOVA to assess the effect of the CDC call to action on HCV screening rates between the 2 groups of patients (Baby Boomers vs. non-Baby Boomers). Figure 1: Average Screening Rates/Practice By Birth Cohort Average # Patients Screened 0 2 4 6 8 10 12 14 Baby Boomer Cohort Non-Boomer Cohort p<0.001 p<0.001 4.17 4.58 12.11 10.97 Pre-CDC Call Post-CDC Call Figure 2: Projected Screening Rates/Practice By Birth Cohor Average # Patients Screened 0 2 4 6 8 10 12 14 Baby Boomer Cohort Non-Boomer Cohort p<0.001 p<0.001 4.17 5.23 12.11 12.47 Pre-CDC Call Post-CDC Call (projected) ● Other population differences were not studied, including physician specialty, patient demographics, HCV risk factors and comorbidities. ● Projected rates assume no other factors or events other than the CDC call to action occur. Our analysis does not capture potential responses to the U.S. Preventive Services Task Force (USPSTF) approval or the Centers for Medicare & Medicaid Services (CMS) endorsement that followed the CDC call to action. ● In the year following the CDC call to action on HCV screening in the Baby Boomer cohort, screening rates rose significantly (10%) in that cohort, but also decreased significantly (10%) in the non-Baby Boomer cohort. ● Further study is needed to see if these changes were due to healthcare professionals changing their criteria for HCV screening from risk factors to birth year cohort. ● It is of interest that projected rates suggest that screening rates in both cohorts will increase significantly in the second year following the CDC call to action, which may indicate further changes in HCV screening criteria over time. The research was funded by Medivo, Inc., New York, NY. JB; co-founder of Medivo, Inc.; CS, TS; employees of Medivo, Inc. ASD, NR; nothing to disclose. 1.Centers for Disease Control and Prevention. Recommendations for the Control of Chronic Hepatitis C Infection Among Persons Born During 1945-1965. MMWR. 2012;61 (No. RR-4):1-32. 2. Medivo Lab Value Exchange Database™ (LVX™). Data on file, 2011 - 2014. ABSTRACT 1447 PRESENTED AT THE LIVER MEETING, THE 65TH ANNUAL MEETING OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES, NOVEMBER 10, 2014, BOSTON, MA
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Page 1: HCV SCREENING OF “BABY BOOMERS” INCREASED · PDF fileintroduction results purpose methods conclusion limitations hcv screening of “baby boomers” increased significantly following

INTRODUCTION RESULTS

PURPOSE

METHODS

CONCLUSION

LIMITATIONS

HCV SCREENING OF “BABY BOOMERS” INCREASED SIGNIFICANTLY FOLLOWING 2012 CDC CALL TO ACTION

BUT SCREENING RATE FELL IN NON-BABY BOOMERS: RESULTS OF A NATIONWIDE LAB TEST DATABASE ANALYSIS

Carol Smyth1, Jason Bhan1, Tatiana Sorokina1, Ajitpal Singh Dhaliwal2, Nancy Reau3, 1Medivo Inc., New York, NY; 2St. Luke’s-Roosevelt Hospital, New York, NY; 3University of Chicago, Chicago, IL.

ABSTRACTPURPOSE: In August 2012, the Centers for Disease Control and Prevention (CDC) called for all Americans in the “Baby Boomer” generation (born 1945 - 1965) to have one-time screening for hepatitis C (HCV). To assess the impact of the CDC call on screening rates, we compared HCV screening rates between the Baby Boomer and the non-Baby Boomer cohorts in the year before vs. the year after the CDC call to action, and also projected screening rates in the 2nd year following the CDC call.

METHODS: Using data from the nationwide Medivo Lab Exchange Database (Medivo Inc., NY, NY), we analyzed 106,272 practices that screened 5,549,760 adults for HCV between August 2011 and April 2014; 1,523,228 (27.4%) were Baby Boomers and 4,026,532 (72.6%) were non-Baby Boomers. We analyzed rates of HCV screening in the year preceding the CDC call to action (August 2011 – July 2012), in the year following the CDC call (August 2012 – July 2013), and projected rates in the 2nd year after the CDC call (data from August 2013 - April 2014, projected to July 2014). 2-way ANOVA was utilized to assess the effect of the CDC call to action on HCV screening rates between the 2 groups (Baby Boomers vs. non-Baby Boomers).

RESULTS: Overall, the average number of patients screened per practice fell in the year following the CDC call (8.14 vs. 7.77; 8.25 projected for the second year following). Turning to the birth cohorts, our analysis shows that in the year following the CDC call to action, there was a 10% increase in the average number of Baby Boomers screened for HCV/practice (4.17 vs. 4.58, p<0.001) and a 10% decrease in the average number of non-Baby Boomers screened/practice (12.11 vs. 10.97, p<0.001). During the second year following the CDC call to action, projections indicate a significant increase in screening in both cohorts compared to the screening rates in the year before the CDC call to action: a 25% increase in the average number of Baby Boomers screened and a 3% increase in the average number of non-Baby Boomers screened (4.17 vs. 5.23 in the Baby Boomers and 12.11 vs. 12.47 in the non-Baby Boomers, p<0.001).

CONCLUSIONS: In the year following the CDC call, screening rates rose significantly (10%) in the Baby Boomer cohort, but also decreased significantly (10%) in the non-Baby Boomer cohort. Further study is needed to see if these changes were due to healthcare professionals changing their criteria for screening from risk factors to birth cohort. It is of interest that projected rates suggest that screening rates in both cohorts will increase significantly in the second year following the CDC call to action, which may indicate further changes in screening criteria.

● People born between 1945-1965 (the “Baby Boomer” generation) account for 75% of chronic hepatitis C virus (HCV) infections in the US.1

● The Centers for Disease Control and Prevention (CDC) estimates that about 1 in 30 people in this birth cohort have HCV, however most of those infected are unaware that they have the virus.1 Deaths from HCV-related illnesses have been rising over the last decade, and are projected to continue to rise.1

● In August 2012, the CDC issued a call to action, recommending that all individuals born between 1945 and 1965 receive a one-time screening for HCV without prior ascertainment of HCV risk.1

● The Medivo Lab Value Exchange Database™ (LVX™) is the largest aggregation of standardized and anonymized lab test results. Insights on clinician practices and testing trends are available, based on this nationwide database.2

● To assess the impact of the CDC call on HCV screening rates, we compared the Baby Boomer screening rates vs. rates in the non-Baby Boomer cohorts in the year before vs. the year after the CDC call to action, and also projected screening rates in the 2nd year following the CDC call to action.

● Overall, the average number of patients screened per practice fell in the year following the CDC call (8.14 vs. 7.77; 8.25 projected for the second year following).

● Turning to the birth cohorts, our analysis shows that in the year following the CDC call to action, there was a 10% increase in the average number of Baby Boomers screened for HCV/practice (4.17 vs. 4.58, p<0.001) and a 10% decrease in the average number of non-Baby Boomers screened/practice (12.11 vs. 10.97, p<0.001). (Figure 1)

● During the second year following the CDC call to action, projections indicate a significant increase in screening in both cohorts compared to the screening rates in the year before the CDC call to action: a 25% increase in the average number of Baby Boomers screened and a 3% increase in the average number of non-Baby Boomers screened (4.17 vs. 5.23 in the Baby Boomers and 12.11 vs. 12.47 in the non-Baby Boomers, p<0.001) (Figure 2).

● At the time of analysis, the Medivo Lab Value Exchange Database™ (LVX™) included over 200,000 practice locations and 27 million patients.

● Using data from the Medivo LVX, we analyzed 106,272 practices that screened adult patients for HCV (N = 5,549,760) between August 2011 and April 2014; 1,523,228 (27.4%) were Baby Boomers and 4,026,532 (72.6%) were non-Baby Boomers.

● We analyzed rates of HCV screening in the year preceding the CDC call to action (August 2011 – July 2012), in the year following the CDC call (August 2012 – July 2013), and projected rates in the second year after the CDC call (data from August 2013 - April 2014, projected to July 2014).

● We used 2-way ANOVA to assess the effect of the CDC call to action on HCV screening rates between the 2 groups of patients (Baby Boomers vs. non-Baby Boomers).

Figure 1: Average Screening Rates/Practice By Birth Cohort

Ave

rage

# P

atie

nts

Scre

ened

0

2

4

6

8

10

12

14

Baby Boomer Cohort Non-Boomer Cohort

p<0.001

p<0.001

4.17 4.58

12.1110.97

Pre-CDC CallPost-CDC Call

Figure 2: Projected Screening Rates/Practice By Birth Cohor

Ave

rage

# P

atie

nts

Scre

ened

0

2

4

6

8

10

12

14

Baby Boomer Cohort Non-Boomer Cohort

p<0.001

p<0.001

4.175.23

12.1112.47

Pre-CDC CallPost-CDC Call(projected)

● Other population differences were not studied, including physician specialty, patient demographics, HCV risk factors and comorbidities.

● Projected rates assume no other factors or events other than the CDC call to action occur. Our analysis does not capture potential responses to the U.S. Preventive Services Task Force (USPSTF) approval or the Centers for Medicare & Medicaid Services (CMS) endorsement that followed the CDC call to action.

● In the year following the CDC call to action on HCV screening in the Baby Boomer cohort, screening rates rose significantly (10%) in that cohort, but also decreased significantly (10%) in the non-Baby Boomer cohort. ● Further study is needed to see if these changes were due to healthcare professionals changing their criteria for HCV screening from risk factors to birth year cohort.

● It is of interest that projected rates suggest that screening rates in both cohorts will increase significantly in the second year following the CDC call to action, which may indicate further changes in HCV screening criteria over time.

The research was funded by Medivo, Inc., New York, NY.

JB; co-founder of Medivo, Inc.; CS, TS; employees of Medivo, Inc. ASD, NR; nothing to disclose.

1.Centers for Disease Control and Prevention. Recommendations for the Control of Chronic Hepatitis C Infection Among Persons Born During 1945-1965. MMWR. 2012;61 (No. RR-4):1-32.2. Medivo Lab Value Exchange Database™ (LVX™). Data on file, 2011 - 2014.

ABSTRACT 1447 PRESENTED AT THE LIVER MEETING, THE 65TH ANNUAL MEETING OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES, NOVEMBER 10, 2014, BOSTON, MA