Federico García1, Raquel Domínguez-Hernández2, Marta Casado3, Juan Macías4, Francisco Téllez5, Juan Manuel Pascasio6, Miguel Ángel Casado2, Juan Carlos Alados7. 1. Unidad de Gestión Clínica de Microbiología Clínica, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada, España. Electronic address: fegarcia@ugr.es. 2. Pharmacoeconomics & Outcomes Research Iberia, Madrid, España. 3. Departamento de Gastroenterología, Complejo Hospitalario Torrecárdenas, Almería, España. 4. Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, España. 5. Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Puerto Real, Puerto Real, Cádiz, España. 6. Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, España. 7. Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España.
Abstract
BACKGROUND: The cascade of care of the hepatitisC are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). METHODS: A decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained form public sources in Andalusia. RESULTS: Of the total estimated population (269,526 patients), 1,389 patients would be referred to the specialised care in the one-step diagnosis and 1,063 in de standard diagnosis, being treated 1,320 and 1,009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3,634 (€11,279 vs €14,923). CONCLUSION: The one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.
BACKGROUND: The cascade of care of the hepatitisC are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). METHODS: A decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained form public sources in Andalusia. RESULTS: Of the total estimated population (269,526 patients), 1,389 patients would be referred to the specialised care in the one-step diagnosis and 1,063 in de standard diagnosis, being treated 1,320 and 1,009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3,634 (€11,279 vs €14,923). CONCLUSION: The one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.
Authors: Rosa López-Martínez; Andrea Arias-García; Francisco Rodríguez-Algarra; Laura Castellote-Bellés; Ariadna Rando-Segura; Guillermo Tarraso; Elena Vargas-Accarino; Isabel Montserrat-Lloan; Albert Blanco-Grau; Andrea Caballero-Garralda; Roser Ferrer-Costa; Tomas Pumarola-Sunye; Maria Buti-Ferret; Rafael Esteban-Mur; Josep Quer; Ernesto Casis-Saez; Francisco Rodríguez-Frías Journal: J Clin Microbiol Date: 2019-12-23 Impact factor: 5.948