Background & Aims

Chronic hepatitis C virus (HCV) infection is a major burden on individuals and health care systems. The Extension for Community Healthcare Outcomes (Project ECHO) enables primary care providers to deliver best-practice care for complex conditions to underserved populations. The US Congress passed the ECHO Act in late 2016, requiring the Department of Health and Human Services to investigate the model. We performed a cost-effectiveness analysis to assess diagnosis and treatment of HCV infection in a primary care patient panel with and without the implementation of Project ECHO.

Methods

We used Markov models to simulate disease progression, quality of life, and life expectancy among individuals with HCV infection and for the general population. Data from the University of New Mexico's ECHO operation for HCV show an increase in treatment rates. Corresponding increases in survival, quality-adjusted life years (QALYs), costs, and resulting budget impact between ECHO and non-ECHO patients with HCV were then compared.

Results

Project ECHO increased costs and QALYs. The incremental cost-effectiveness ratio of ECHO was $10,351 per QALY compared with the status quo; >99.9% of iterations fell below the willingness-to-pay threshold of $100,000 per QALY. We were unable to confirm whether the increase in rates of treatment associated with Project ECHO were due to increased or more targeted screening, higher adherence, or access to treatment. Our sensitivity analyses show that the results are largely independent of the cause. Budget impact analysis shows payers would have to invest an additional $339.54 million over a 5-year period to increase treatment by 4446 patients, per 1 million covered lives.

Conclusion

Using a simulated primary care patient panel, we showed that Project ECHO is a cost-effective way to find and treat patients with HCV infection at scale using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States, but high budgetary costs suggest that incremental rollout of ECHO may be best.

中文翻译：

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通过初级保健提供者扩大治疗丙型肝炎病毒感染途径的成本效益

背景与目标

慢性丙型肝炎病毒（HCV）感染是个人和医疗保健系统的主要负担。社区保健成果扩展（ECHO项目）使初级保健提供者能够为服务不足的人群提供针对复杂情况的最佳实践护理。美国国会于2016年末通过了《回声法案》，要求卫生与公共服务部对该模型进行调查。我们进行了成本效益分析，以评估在是否实施Project ECHO的情况下在初级保健患者小组中进行HCV感染的诊断和治疗。

方法

我们使用马尔可夫模型来模拟HCV感染个体以及一般人群的疾病进展，生活质量和预期寿命。来自新墨西哥大学ECHO部门的HCV数据显示治疗率有所提高。然后比较了HCV的ECHO和非ECHO患者之间相应的生存率增加，质量调整生命年（QALYs），成本以及由此产生的预算影响。

结果

ECHO项目增加了成本和QALY。与现状相比，ECHO的成本效益比为每QALY 10,351美元；> 99.9％的迭代低于每个QALY的100,000美元的支付意愿阈值。我们无法确定与ECHO项目相关的治疗率的增加是否是由于更多或更有针对性的筛查，更高的依从性或获得治疗所致。我们的敏感性分析表明，结果在很大程度上与原因无关。预算影响分析显示，付款人将需要在5年内额外投资3.594亿美元，才能使每100万受保生命增加4446名患者的治疗。

结论

使用模拟的初级保健患者小组，我们证明了ECHO项目是使用现有的初级保健提供者大规模查找和治疗HCV感染患者的一种经济有效的方法。在美国，这种方法可以大大减轻慢性HCV感染的负担，但是高昂的预算费用表明，逐步推广ECHO可能是最好的选择。