Thilo Rattay1, Ian P Dumont2, Hauke S Heinzow3, David W Hutton4. 1. School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan; Medical School, University of Münster, Münster, Germany. Electronic address: thilo.rattay@uni-muenster.de. 2. School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan; Ross School of Business, University of Michigan, Ann Arbor, Michigan. 3. University Hospital, Medical Clinic B - Gastroenterology and Hepatology, University of Münster, Münster, Germany. 4. School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND & AIMS: Chronic hepatitis C virus (HCV) infection is a major burden on individuals and health care systems. The Extension for Community Healthcare Outcomes (Project ECHO) enables primary care providers to deliver best-practice care for complex conditions to underserved populations. The US Congress passed the ECHO Act in late 2016, requiring the Department of Health and Human Services to investigate the model. We performed a cost-effectiveness analysis to assess diagnosis and treatment of HCV infection in a primary care patient panel with and without the implementation of Project ECHO. METHODS: We used Markov models to simulate disease progression, quality of life, and life expectancy among individuals with HCV infection and for the general population. Data from the University of New Mexico's ECHO operation for HCV show an increase in treatment rates. Corresponding increases in survival, quality-adjusted life years (QALYs), costs, and resulting budget impact between ECHO and non-ECHO patients with HCV were then compared. RESULTS: Project ECHO increased costs and QALYs. The incremental cost-effectiveness ratio of ECHO was $10,351 per QALY compared with the status quo; >99.9% of iterations fell below the willingness-to-pay threshold of $100,000 per QALY. We were unable to confirm whether the increase in rates of treatment associated with Project ECHO were due to increased or more targeted screening, higher adherence, or access to treatment. Our sensitivity analyses show that the results are largely independent of the cause. Budget impact analysis shows payers would have to invest an additional $339.54 million over a 5-year period to increase treatment by 4446 patients, per 1 million covered lives. CONCLUSION: Using a simulated primary care patient panel, we showed that Project ECHO is a cost-effective way to find and treat patients with HCV infection at scale using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States, but high budgetary costs suggest that incremental rollout of ECHO may be best.
BACKGROUND & AIMS:Chronic hepatitis C virus (HCV) infection is a major burden on individuals and health care systems. The Extension for Community Healthcare Outcomes (Project ECHO) enables primary care providers to deliver best-practice care for complex conditions to underserved populations. The US Congress passed the ECHO Act in late 2016, requiring the Department of Health and Human Services to investigate the model. We performed a cost-effectiveness analysis to assess diagnosis and treatment of HCV infection in a primary care patient panel with and without the implementation of Project ECHO. METHODS: We used Markov models to simulate disease progression, quality of life, and life expectancy among individuals with HCV infection and for the general population. Data from the University of New Mexico's ECHO operation for HCV show an increase in treatment rates. Corresponding increases in survival, quality-adjusted life years (QALYs), costs, and resulting budget impact between ECHO and non-ECHO patients with HCV were then compared. RESULTS: Project ECHO increased costs and QALYs. The incremental cost-effectiveness ratio of ECHO was $10,351 per QALY compared with the status quo; >99.9% of iterations fell below the willingness-to-pay threshold of $100,000 per QALY. We were unable to confirm whether the increase in rates of treatment associated with Project ECHO were due to increased or more targeted screening, higher adherence, or access to treatment. Our sensitivity analyses show that the results are largely independent of the cause. Budget impact analysis shows payers would have to invest an additional $339.54 million over a 5-year period to increase treatment by 4446 patients, per 1 million covered lives. CONCLUSION: Using a simulated primary care patient panel, we showed that Project ECHO is a cost-effective way to find and treat patients with HCV infection at scale using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States, but high budgetary costs suggest that incremental rollout of ECHO may be best.
Authors: April D Kimmel; Steven P Masiano; Rose S Bono; Erika G Martin; Faye Z Belgrave; Adaora A Adimora; Bassam Dahman; Hadiza Galadima; Lindsay M Sabik Journal: AIDS Care Date: 2018-05-30
Authors: Brian R Wood; Karin Bauer; Richard Lechtenberg; Susan E Buskin; Lea Bush; Jeff Capizzi; Beth Crutsinger-Perry; Steven J Erly; Timothy W Menza; Jennifer R Reuer; Matthew R Golden; James P Hughes Journal: J Acquir Immune Defic Syndr Date: 2022-08-15 Impact factor: 3.771
Authors: Hyun-Seok Kim; Rosalia Guerrero; Shane W Reader; Maria Daheri; Maya Balakrishnan; Catherine L Troisi; Hashem B El-Serag; Aaron P Thrift Journal: Open Forum Infect Dis Date: 2020-06-02 Impact factor: 3.835
Authors: María Buti; Raquel Domínguez-Hernández; Miguel Ángel Casado; Eliazar Sabater; Rafael Esteban Journal: PLoS One Date: 2018-11-28 Impact factor: 3.240