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Kapadia SN, Eckhardt BJ, Leff JA, Fong C, Mateu-Gelabert P, Marks KM, Aponte-Melendez Y, Schackman BR. Cost of providing co-located hepatitis C treatment at a syringe service program exceeds potential reimbursement: Results from a clinical trial. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100109. [PMID: 36644226 PMCID: PMC9836210 DOI: 10.1016/j.dadr.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
Background Co-located hepatitis C treatment at syringe service programs (SSP) is an emerging model of care for people who inject drugs (PWID). Implementation of these models can be informed by understanding the program costs. Methods We conducted an economic evaluation of a hepatitis C treatment intervention at an SSP in New York City implemented as one arm of a randomized trial from 2017 to 2021. Start-up and operating costs were determined from the treatment program's perspective using micro-costing and were compared to potential Medicaid reimbursement. We applied nationally representative unit costs and wage rates. Results are reported in 2020 USD. Results The treatment program was staffed by one physician and one care coordinator. Participants were offered hepatitis C clinical evaluation and treatment, a 45-min reinfection prevention education session, and additional care coordination as needed. The trial enrolled 84 PWID with hepatitis C in the intervention arm; 64 initiated treatment and 55 achieved sustained virological response. Start-up costs including training and equipment totaled $4677. Overhead costs including rent, utilities and software totaled $2229 per month. Clinical and care coordination totaled $4867 per participant, of which $3722 was care coordination. The total cost excluding startup was $6035 per enrolled participant and $7921 per treated participant; estimated potential reimbursement was $628 per enrolled participant. Conclusion Our results provide insight to US-based SSPs seeking to provide co-located hepatitis C care and highlight the intensive care coordination services provided. Successful implementation likely requires funding sources beyond health insurers or substantial changes to insurance reimbursement for care coordination.
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Affiliation(s)
- Shashi N Kapadia
- Weill Cornell Medicine, Division of Infectious Diseases, 1300 York Ave Rm A-421, New York, NY 10065, United States
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
| | - Benjamin J Eckhardt
- Division of Infectious Diseases, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States
| | - Jared A Leff
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
| | - Kristen M Marks
- Weill Cornell Medicine, Division of Infectious Diseases, 1300 York Ave Rm A-421, New York, NY 10065, United States
| | - Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, United States
| | - Bruce R Schackman
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
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Hayward KL, McKillen BJ, Horsfall LU, McIvor C, Liew K, Sexton J, Johnson AL, Irvine KM, Valery PC, McPhail SM, Britton LJ, Rosenberg W, Weate I, Williams S, Powell EE. Towards collaborative management of nonalcoholic fatty liver disease (TCM-NAFLD): a 'real-world' pathway for fibrosis risk assessment in primary care. Intern Med J 2021; 52:1749-1758. [PMID: 34139066 DOI: 10.1111/imj.15422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal strategy to support primary care practitioners (PCPs) to assess fibrosis severity in nonalcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear. AIMS We aimed to examine the feasibility of using a 2-step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis-4 Index) with transient elastography (FibroScan®) to streamline NAFLD referrals from a 'routine' primary care population to specialist hepatology management clinics (HMC). METHODS The 2-step "Towards Collaborative Management of NAFLD" (TCM-NAFLD) fibrosis risk assessment pathway was implemented at two outer metropolitan primary healthcare practices in Brisbane. Patients aged ≥18 years with a new or established PCP-diagnosis of NAFLD were eligible for assessment. The pathway triaged patients at "high risk" of clinically significant fibrosis to HMC for specialist review, and "low risk" patients to receive ongoing management and longitudinal follow-up in primary care. RESULTS A total of 162 patient assessments between Jun-2019 and Dec-2020 were included. Mean age was 58.7 ± 11.7 years, 30.9% were male, 54.3% had type 2 diabetes or impaired fasting glucose, and mean body mass index was 34.2 ± 6.9 kg/m2 . 122 patients were considered "low risk" for clinically significant fibrosis, two patients had incomplete assessments, and 38 (23.5%) were triaged to HMC. Among 31 completed HMC assessments to date, 45.2% were considered to have clinically significant (or more advanced) fibrosis, representing 9.2% of 153 completed assessments. CONCLUSION Implementation of the 2-step TCM-NAFLD pathway streamlined hepatology referrals for NAFLD and may facilitate a more cost-effective and targeted use of specialist hepatology resources. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Benjamin J McKillen
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Leigh U Horsfall
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Carolyn McIvor
- Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia
| | - Katerina Liew
- Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia
| | - Jo Sexton
- Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia
| | - Amy L Johnson
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Katharine M Irvine
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Mater Research, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,QIMR Berghofer Medical Research Institute; Herston QLD, Australia
| | - Steven M McPhail
- Clinical Informatics Directorate, Metro South Health; Woolloongabba QLD, Australia.,Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology; Kelvin Grove QLD, Australia
| | - Laurence J Britton
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia.,Greenslopes Clinical School, Faculty of Medicine, The University of Queensland, Greenslopes QLD, Australia
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London; London, UK.,The Royal Free London, NHS Foundation Trust; London, UK
| | - Ingrid Weate
- Jimboomba Medical Centre; Jimboomba QLD, Australia
| | | | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
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