Three unique testing interventions all increased hepatitis C virus screening rates among baby boomers, but also increased costs compared with standard-of-care risk-based testing, according to recent study data.
An electronic health record (EHR) best practice alert intervention showed the best ratio of effect size vs. incremental costs, aside from startup costs, and may therefore lead to more widespread adoption compared with the other interventions, investigators concluded.
“In the United States, individuals born as part of the 1945-1965 birth cohort (BC) have a prevalence of HCV infection as high as five times greater than other BCs,” investigators wrote. “To increase hepatitis C case identification within the BC, the Centers for Disease control and Prevention (CDC) and the U.S. Preventive Services Task Force expanded prior risk-based testing recommendations to include one-time HCV testing for U.S. residents born during 1945-1965.”
As a result, the CDC foundation sponsored the Birth-Cohort Evaluation to Advance Screening and Testing for Hepatitis C (BEST-C) study to better understand the costs and effects of testing this birth cohort for HCV in primary care settings.
Researchers from three large health care systems each performed a randomized trial of a unique testing intervention between December 2012 and March 2014. The first trial randomly assigned eligible patients to receive HCV screening information and reminder letters by mail or be tracked as controls (n = 8,992); the second compared standard-of-care testing and an EHR best practice alert notifying a medical assistant that a scheduled patient was eligible for HCV testing (n = 14,475); and the third compared standard-of-care testing and a physician office-based direct patient solicitation to recruit patients for HCV testing (n = 8,873).
Each center developed and assessed their intervention for its effect on HCV antibody testing, diagnosis, and costs compared with standard-of-care testing.
Collectively, intervention led to substantial increases in HCV testing rates vs. standard-of-care testing. The repeated mailing intervention resulted in 26.9% screening rates vs. 1.4% for standard of care; the best practice alert resulted in 30.9% screening rates vs. 3.6%, and the patient solicitation intervention resulted in 63.5% screening rates vs. 2%.
Multilevel multivariable models also showed intervention resulted in significantly higher risk ratios for testing after adjusting for sex, birth year, race, insurance type and median household income. The aRR for the repeated mailing intervention was 19.2 (95% CI, 9.7-38.2), for the best practice alert it was 13.2 (95% CI, 3.6-48.6), and for the patient solicitation intervention it was 32.9 (95% CI, 19.3-56.1).
Ultimately, the best practice alert intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, and $3 without fixed startup costs), and also the lowest incremental cost per new case identified after excluding fixed startup costs ($1,691).
These findings suggest “integrating BC testing into standard-of-care testing is likely to be more cost-effective and practical than instituting an intervention in addition to standard-of-care testing, such as repeated mailings and patient solicitation,” investigators concluded. – by Adam Leitenberger
Disclosures: One of the researchers reports receiving grants from Gilead, AbbVie, Novartis and Janssen, and consults for Merck, Bristol-Myers Squibb, Gilead and AbbVie, and serves on the speakers’ bureau for Intercept. Another reports he has received grants form Gilead and Conatus, and another reports he has received grants from Gilead.