Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study.
Adult
Antiviral Agents
/ economics
Community Health Centers
Cost-Benefit Analysis
Counselors
Female
Hepatitis C Antibodies
/ blood
Hepatitis C, Chronic
/ complications
Humans
Life Expectancy
Liver Cirrhosis
/ economics
Male
Mass Screening
Middle Aged
Opioid Epidemic
Oregon
Point-of-Care Testing
/ economics
Quality-Adjusted Life Years
RNA, Viral
/ blood
Serologic Tests
/ economics
United States
United States Health Resources and Services Administration
Computer simulation
Health centers
Hepatitis C
Testing
Treatment
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
10
01
2020
revised:
21
04
2020
accepted:
19
05
2020
pubmed:
1
7
2020
medline:
15
12
2020
entrez:
1
7
2020
Statut:
ppublish
Résumé
The opioid epidemic has been associated with an increase in hepatitis C virus (HCV) infections. Federally qualified health centers (FQHCs) have a high burden of hepatitis C disease and could serve as venues to enhance testing and treatment. We estimated clinical outcomes and the cost-effectiveness of hepatitis C testing and treatment at US FQHCs using individual-based simulation modeling. We used individual-level data from 57 FQHCs to model 9 strategies, including permutations of HCV antibody testing modality, person initiating testing, and testing approach. Outcomes included life expectancy, quality-adjusted life-years (QALY), hepatitis C cases identified, treated and cured; and incremental cost-effectiveness ratios. Compared with current practice (risk-based with laboratory-based testing), routine rapid point-of-care testing initiated and performed by a counselor identified 68% more cases after (nonreflex) RNA testing in the first month of the intervention and led to a 17% reduction in cirrhosis cases and a 22% reduction in liver deaths among those with cirrhosis over a lifetime. Routine rapid testing initiated by a counselor or a clinician provided better outcomes at either lower total cost or at lower cost per QALY gained, when compared with all other strategies. Findings were most influenced by the proportion of patients informed of their anti-HCV test results. Routine anti-HCV testing followed by prompt RNA testing for positives is recommended at FQHCs to identify infections. If using dedicated staff or point-of-care testing is not feasible, then measures to improve immediate patient knowledge of antibody status should be considered.
Sections du résumé
BACKGROUND
The opioid epidemic has been associated with an increase in hepatitis C virus (HCV) infections. Federally qualified health centers (FQHCs) have a high burden of hepatitis C disease and could serve as venues to enhance testing and treatment.
METHODS
We estimated clinical outcomes and the cost-effectiveness of hepatitis C testing and treatment at US FQHCs using individual-based simulation modeling. We used individual-level data from 57 FQHCs to model 9 strategies, including permutations of HCV antibody testing modality, person initiating testing, and testing approach. Outcomes included life expectancy, quality-adjusted life-years (QALY), hepatitis C cases identified, treated and cured; and incremental cost-effectiveness ratios.
RESULTS
Compared with current practice (risk-based with laboratory-based testing), routine rapid point-of-care testing initiated and performed by a counselor identified 68% more cases after (nonreflex) RNA testing in the first month of the intervention and led to a 17% reduction in cirrhosis cases and a 22% reduction in liver deaths among those with cirrhosis over a lifetime. Routine rapid testing initiated by a counselor or a clinician provided better outcomes at either lower total cost or at lower cost per QALY gained, when compared with all other strategies. Findings were most influenced by the proportion of patients informed of their anti-HCV test results.
CONCLUSIONS
Routine anti-HCV testing followed by prompt RNA testing for positives is recommended at FQHCs to identify infections. If using dedicated staff or point-of-care testing is not feasible, then measures to improve immediate patient knowledge of antibody status should be considered.
Identifiants
pubmed: 32603791
pii: S0002-9343(20)30527-1
doi: 10.1016/j.amjmed.2020.05.029
pmc: PMC8041089
mid: NIHMS1607562
pii:
doi:
Substances chimiques
Antiviral Agents
0
Hepatitis C Antibodies
0
RNA, Viral
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e641-e658Subventions
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Organisme : NCHHSTP CDC HHS
ID : U38 PS004644
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA044085
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI060354
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
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