Sabrina A Assoumou1, Shayla Nolen2, Liesl Hagan3, Jianing Wang2, Golnaz Eftekhari Yazdi2, William W Thompson3, Kenneth H Mayer4, Jon Puro5, Lin Zhu6, Joshua A Salomon7, Benjamin P Linas8. 1. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA. Electronic address: sabrina.assoumou@bmc.org. 2. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA. 3. Prevention Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Ga. 4. The Fenway Institute, Fenway Health, Boston, MA; Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 5. OCHIN, Inc., Portland, Ore. 6. Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA. 7. Stanford University School of Medicine, CA. 8. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA; Department of Epidemiology, Boston University School of Public Health, MA.
Abstract
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.
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.
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Authors: Sabrina A Assoumou; Abriana Tasillo; Jared A Leff; Bruce R Schackman; Mari-Lynn Drainoni; C Robert Horsburgh; M Anita Barry; Craig Regis; Arthur Y Kim; Alison Marshall; Sheel Saxena; Peter C Smith; Benjamin P Linas Journal: Clin Infect Dis Date: 2018-01-18 Impact factor: 20.999
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