BlueCross BlueShield of Tennessee Medical Policy Manual

Urinary Metabolite Tests for Adherence to Direct-Acting Antiviral Medications for Hepatitis C


Metabolites of some direct-acting antiviral (DAA) medications can be measured in the urine. Measurement of urine drug levels reflects serum levels. This measurement has the potential component of a therapeutic intervention for hepatitis C, with the intent of improving treatment response by monitoring adherence.

The evidence for monitoring adherence to DAAs by measuring urinary metabolites in individuals who have hepatitis C and are receiving DAA medications includes no published studies that evaluate the impact on adherence to DAA agents.




The evidence is insufficient to determine the impact of the technology on health outcomes.


American Association for the Study of Liver Diseases / Infectious Disease Society of America. (2016, July). Recommendations for testing, managing, and treating hepatitis C. Retrieved November 17, 2016 from  

American Association for the Study of Liver Diseases. (2015). HCV guidance: A summary of recommendations for when and in whom to initiate HCV therapy. Retrieved September 14, 2015 from

American College of Gastroenterology. (2013). Diagnosis, management, and treatment of hepatitis C: An update. Retrieved September 14, 2015 from

Department of Veteran’s Affairs. (2016, September). Chronic hepatitis C virus (HCV) infection: treatment considerations. Retrieved November 17, 2016 from

Larrey, D., Ripault, M., & Pageaux, G. (2014). Patient adherence issues in the treatment of hepatitis C. DovePress Review, 2014 (8), 763-773. (Level 5 evidence)




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