Integrating Hepatitis C Care for opioid substitution treatment patients: Feasibility, Clinical and Cost Effectiveness

Geoff Mccombe, Davina Swan, John S Lambert, Eileen O'connor, Zoe Ward, Peter Vickerman, Gordana Avramovic, Des Crowley, Willard Tinago, Nyashadzaishe Mafikureva, Walter Cullen

Keywords: primary health care; hepatitis C; integrated HCV care; people who inject drugs

Hepatitis C is a common infection, often not diagnosed or treated and therefore associated with potentially preventable chronic liver disease. As many people who inject drugs (PWID) are unaware of their infection, new strategies to reach such individuals are necessary, including testing strategies to increase the number diagnosed and improved care pathways to ensure those diagnosed are successfully linked to HCV evaluation and treatment.

Research questions:
The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice.

A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The ‘complex intervention’ comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions.

Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention from the clinical records of 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of patients who had a liver fibroscan 17/101(16.8%) vs 52/100(52.0%); p<0.001), had attended hepatology/infectious diseases services 51/101(50.5%) vs 61/100(61.0%); p=0.002), and initiated treatment 20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%.

The complex intervention has the potential to impact on patient care, improving access to assessment and treatment in a cost effective manner.

Points for discussion: