Article: Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study—J E Brady et al.
Source: Hepatology. 2017 Jan;65(1):44-53. doi: 10.1002/hep.28880. Epub 2016 Nov 25.
Study Aims and Results
It is estimated that 4 of 5 HCV patients diagnoses are missed based on risk based testing—the current standard of care. Risk based HCV antibody testing includes Baby Boomer testing. In order to understand the most effective testing model a study was conducted using three interventions or testing models at different centers:
- Center 1: A letter delivered to Baby Boomers by the United States Post Office advising them to be tested
- Center 2: Electronic health record (EHR)-best practice alert (BPA) that would alert the medical provider to ask the patient if they wanted to be tested for hepatitis C
- Center 3: Physician office based direct patient solicitation – the medical provider would ask a patient (Baby Boomer) if they wanted to be tested for hepatitis C
The goal is to increase the number of people who would be identified with HCV and compare the results to the current —risk based testing (standard of care (SOC)). The start-up costs and the costs of the antibody test were factored in to the interventions.
Electronic health record (EHR-the best practice alert (BPA) intervention was found to have the lowest incremental cost ($24.00 with fixed startup costs, $3 without) and “the lowest cost per new case identified after omitting fixed startup costs ($1691).”
Electronic health records are a good strategy to trigger a medical provider to ask patients to be tested for hepatitis C. The results of aged-based testing of hepatitis C has not been as successful in driving the undiagnosed HCV patients to medical care as originally believed. There will need to be a large investment in electronic health records as the next logical step. I have to wonder how this would be received in a physician’s office because of the time constraints that so many primary care offices are under these days.
Alan Franciscus is the Executive Director of the Hepatitis C Support Project and the Editor-in-Chief of the HCV Advocate Website
MedicalResearch.com: What is the background for this study?
Response: It is estimated that there are over 3 million people in the United States living with Hepatitis C virus (HCV) infection. Risk factors for infection include, but are not limited to, injection drug use, history of incarceration, HIV coinfection, and blood transfusion prior to July 1992. Several direct acting antiviral medications have recently been approved to treat, and in the majority of cases, cure HCV.
The first step in identifying infected persons so that they may be cured of this infection is a blood test for antibodies to HCV.
The greatest burden of HCV is among persons born from 1945 through 1965; the baby boomer birth cohort. Therefore, in 2012, the Centers for Disease Control and Prevention (CDC) published updated HCV antibody testing recommendations to include one-time testing of persons in the birth cohort. The United States Preventive Services Task Force (USPSTF) published similar recommendations the following year. Additionally, in recent years there has been an increase in HCV infections related to injection drug use among younger people.
We used commercial insurance claims data to describe trends in HCV antibody testing over a 10-year period (2005 – 2014), both to assess the impact of the CDC and USPSTF testing recommendations, and to better understanding how trends varied by gender, age group, and geography.
Too often, news coverage of hepatitis C focuses on the cost of new drugs and not the importance of determining which patients have hepatitis C and getting them into effective care.
An estimated 50 percent to 80 percent of those with hepatitis C are unaware of their infection. Experts believe that is a group of some 800,000 people. Screening them all could prevent 120,000 deaths – not to mention stop the spread of infection to others. Simple blood testing and liver damage assessment, seems like a low price to save 120,000 lives – or thought of differently, preventing a deadly plane crash every day for the next year.
It is well known across medicine who should be screened (everyone born between 1945 and 1965, plus at-risk individuals such as those with HIV or patients on kidney dialysis, men who have sex with men, and people who have used injectable drugs now or in the past). But we at the Mid-Atlantic Permanente Research Institute (MAPRI), the institutional research arm of Kaiser Permanente of the Mid-Atlantic States and the Mid-Atlantic Permanente Medical Group (MAPMG), set out to find a way to actually make it happen. Data suggests only a few percent get screened (0.7-12.7 percent) – and less than half of those end up actually linked to care they need. If others could adopt our innovative program, the impact could be tremendous.