Source: Abstract # FRI-458 The Cost-effectiveness of a one time hepatitis C virus antibody test followed by treatment for all Americans ages 18 and older as compared to current testing recommendations in the United States—D. B. Rein et. al.
Background and Aims: In the United States persons born between 1945 and 1965 account for 75% of reported Hepatitis C and 73% of all hepatitis C associated mortality. In 2012 the CDC made the recommendation to screen all adults born between 1945 and 1965 for hepatitis C virus (HCV). Our integrated healthcare system implemented a workflow such that every newly diagnosed HCV patient born between 1945 and 1965 was linked to an infectious disease provider. The purpose of this study was to assess the success of that linkage to care process.
SSM Health Dean Medical Group implemented a health maintenance request reminder for primary care providers to initiate a one time HCV antibody for all patients born between 1945 and 1965.
Medical records were then reviewed for those patients. Patients identified with positive antibody had a reflex lab to test for HCV RNA. Patients with positive antibody and detected virus were referred to infectious disease and set up with an appointment for treatment assessment. Pharmacy screened patients to verify attempts were made to set up an appointment. HCV treatment was managed by a collaborative care team comprised of an infectious disease provider, HCV nurse, and a pharmacist. The primary outcome was percent of patients linked to care. Secondary endpoints include time from diagnosis to office visit, fibrosis stage, and SVR 12.
At the time of analysis11,277patients bornbetween1945 and 1965 had been screened for HCV antibody. Of those patients screened without prior HCV diagnosis, 158 (1.40%) had positive HCV antibody and 36 (0.32%) with detected HCV viral RNA. One patient was excluded from analysis based on detected but unquantifiable viral load. Another patient was excluded based on transferring care after initial office visit.
Of the 34 patients analyzed 100% of them were linked to infectious disease. A total of 7 patients (20.6%) were started on therapy and 7 patients (20.6%) had completed therapy at time of abstract submission.
Insurance companies denied coverage for 4 patients (11.8%) for not meeting fibrosis stage criteria. The remaining 16 patients (47.0%) were awaiting office visits or insurance approval. Updated results will be presented at the 2017 International Liver Conference.
Conclusions: Linkage to care and treatment remains a major global barrier to reduce spread of infection and disease. Our health system was able to link all patients to care and treat those eligible.Share This Page