Details:

Alternative Title:
Am J Med
Personal Author:
ASSOUMOU, Sabrina A. ; NOLEN, Shayla ; HAGAN, Liesl ; WANG, Jianing ; EFTEKHARI YAZDI, Golnaz ; ... More +
ASSOUMOU, Sabrina A. ; NOLEN, Shayla ; HAGAN, Liesl ; WANG, Jianing ; EFTEKHARI YAZDI, Golnaz ; THOMPSON, William W. ; MAYER, Kenneth H. ; PURO, Jon ; ZHU, Lin ; SALOMON, Joshua A. ; LINAS, Benjamin P. Less -
Description:
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 (ICERs).

Results:

Compared to 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 (non-reflex) RNA testing in the first month of the intervention, 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 to 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.


Subject:
[+]
Adult
Antiviral Agents
Community Health Centers
Cost-Benefit Analysis
Counselors
Female
Hepatitis C, Chronic
Hepatitis C Antibodies
Humans
Life Expectancy
Liver Cirrhosis
Male
Mass Screening
Middle Aged
Opioid Epidemic
Point-of-Care Testing
Quality-Adjusted Life Years
RNA, Viral
Serologic Tests

Source:
Am J Med. 133(11):e641-e658
Pubmed ID:
32603791
Pubmed Central ID:
PMC8041089
Document Type:
Journal Article
Funding:
K23 DA044085/DA/NIDA NIH HHS/United States ; P30 DA040500/DA/NIDA NIH HHS/United States ; R01 DA046527/DA/NIDA NIH HHS/United States ; U38 PS004644/PS/NCHHSTP CDC HHS/United States
K23 DA044085/DA/NIDA NIH HHS/United States ; P30 DA040500/DA/NIDA NIH HHS/United States ; R01 DA046527/DA/NIDA NIH HHS/United States ; U38 PS004644/PS/NCHHSTP CDC HHS/United States Less -
Name as Subject:
United States. Health Resources and Services Administration.
Place as Subject:
Oregon ; United States
Oregon ; United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:0fd0c200cf6d2f2c05eea27c4adc8b100a0107acb326c6b609162f05edca4cfa
File Type:

Supporting Files

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  	NIHMS1607562-supplement-supplementary.docx	docx

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