Uptake of Hepatitis C Screening, Characteristics of Patients Tested, and Intervention Costs in the BEST-C Study

Details

• Alternative Title:
  Hepatology
• Personal Author:
  Brady, Joanne E. ; Liffmann, Danielle K. ; Yartel, Anthony ; Kil, Natalie ; Federman, Alex D. ; Kannry, Joseph ; Jordan, Cynthia ; Massoud, Omar I. ; Nerenz, David R ; Brown, Kimberly A. ; Smith, Bryce D. ; Vellozzi, Claudia ; Rein, David B.
• Description:
  Background
  
  From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing.
  
  Rationale
  
  To estimate the effects of interventions conducted as part of the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C study on hepatitis C virus (HCV) testing and costs among persons of the 1945–1965 birth-cohort (BC).
  
  Main Results
  
  Intervention resulted in substantially higher HCV testing rates compared to standard-of-care (26.9% vs. 1.4% for repeated-mailing, 30.9% vs. 3.6% for BPA, and 63.5% vs. 2.0% for patient-solicitation), and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% Confidence Interval (CI) 9.7–38.2] for repeated-mailing, 13.2 [95% CI 3.6–48.6] for BPA, and 32.9 [95% CI 19.3–56.1] for patient-solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1,691).
  
  Conclusion
  
  HCV testing interventions resulted in an increase in BC testing compared to standard-of-care but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared to the other interventions.
  
  
• Subjects:
  Aged Cohort Studies Female Health Care Costs Hepacivirus Hepatitis C Hepatitis C Antibodies Humans Male Mass Screening Middle Aged Randomized Controlled Trials As Topic Serologic Tests

  More +
• Source:
  Hepatology. 65(1):44-53.
• Pubmed ID:
  27770543
• Pubmed Central ID:
  PMC5582998
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  65
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:14c3039748da28c98d76cd7d94fb43a308bc2da6f69683a189b57d1e81bfeb2a
• Download URL:
  https://stacks.cdc.gov/view/cdc/48006/cdc_48006_DS1.pdf
• File Type:
  [PDF - 413.43 KB ]