Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study - 05/11/20
, Shayla Nolen, MPH a, Liesl Hagan, MPH c, Jianing Wang, MSc a, Golnaz Eftekhari Yazdi, MSc a, William W. Thompson, PhD c, Kenneth H. Mayer, MD d, e, Jon Puro, MPA-HA f, Lin Zhu, PhD g, Joshua A. Salomon, PhD h, Benjamin P. Linas, MD, MPH a, b, iAbstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Computer simulation, Health centers, Hepatitis C, Testing, Treatment
Plan
| Funding: This project was funded by the US Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (NU38PS004644), which contributed to the conception, design, and analysis and the decision to submit the manuscript for publication. Support was also obtained from the National Institute of Drug Abuse (K23 DA044085, R01 DA046527, P30 DA040500). The findings and conclusions are those of the authors and do not necessarily represent the official position of the CDC or the National Institutes of Health. This study was approvied by the BUMC Institutional Review Board. |
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| Conflict of Interest: None. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 133 - N° 11
P. e641-e658 - novembre 2020 Retour au numéro
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