Characteristics of patients tested for hepatitis C and intervention costs in the best-C study
Brady JE, Liffmann D, Yartel AK, Kil NB, Federman AD, Jordan CE, Massoud OI, Nerenz DR, Brown K, Smith B, Vellozzi C, Rein DB. Characteristics of patients tested for hepatitis C and intervention costs in the best-C study. Hepatology 2015; 62(S1):1081A-1082A.
Given that 80% of Hepatitis C virus (HCV)-infected Americans were born during the years 1945-1965, the Centers for Dis-ease Control and Prevention (CDC) and the U.S Preventive Services Task Force recommended a one-time HCV antibody test for adults born in the 1945-1965 birth cohort (BC). CDC’s Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C was designed to assess the impact of testing interventions on the probability of HCV testing in primary care (PC) among BC patients as compared to usual care and the incremental costs per person tested and per case identified at each site. From December 2012-March 2014, 3 health systems implemented independent testing interventions using randomized designs to compare intervention testing and identification rates to usual care. Site 1 mailed paid lab test orders and repeated reminders to a randomly selected list of active patients compared to a second list who received no mailings. Site 2 created an electronic health record best practice alert (BPA) implemented or not implemented based on cluster randomized design. Site 3 directly solicited patients following a scheduled PC visit and used a cluster randomized crossover design. Multilevel multivariable regression was used to estimate the risk ratio for HCV testing; activity-based costing was used to estimate costs. HCV testing was significantly more common for all interventions compared to controls; adjusted risk ratio (aRR) 19.2, (95% CI, 9.7–38.2), 13.2 (95% CI, 3.6–48.6), and 32.9 (95% CI 19.3–56.1) for sites 1, 2, and 3, respectively. The BPA intervention had the lowest incremental cost per person tested ($25 with fixed startup costs, $3 without startup costs). The incremental cost per new case identified under usual care ranged from $3,771-$6207 across sites. All interventions increased HCV testing among the BC compared to usual care, but also increased the costs. The cost per case identified excluding startup costs was lowest for the BPA intervention ($1,691), suggesting that integrating BC testing into usual care is likely to be more cost-effective than instituting an intervention in addition to usual care, e.g., repeated-mailings and patient-solicitation.