A cost-benefit analysis of primary versus hospital-based specialist care for direct acting antiviral hepatitis C treatment

Author: Palmer A, Wade A, Draper B, Howell J, Doyle J, Petrie D, Thompson A, Wilson D, Hellard M, Scott N

Theme: Models of Care Year: 2019

Hepatitis C virus elimination may be possible by scaling up direct-acting antiviral (DAA) treatment.
Due to the safety and simplicity of DAA treatment, primary-based models of care are now feasible,
efficacious and may be cheaper than hospital-based specialist care. The Prime Study was a
randomised controlled trial comparing the uptake of DAA treatment and cure outcomes between
primary and hospital-based care settings. In this paper, we use Prime Study data to estimate the cost
of initiating treatment for people diagnosed with hepatitis C in primary care compared to hospitalbased care.
Description of model of care/intervention:
The total economic costs associated with delivering DAA treatment (post hepatitis C diagnosis)
within the Prime study – including health provider time/training, medical tests, equipment, logistics
and pharmacy costs – were collected. Appointment data were used to estimate the number/type of
appointments required to initiate treatment in each case, or the stage at which loss to follow up
Among the hepatitis C patients randomised to be treated within primary care, 43/57 (75%)
commenced treatment at a mean cost of A$1,007 (range: A$934-1,099) per patient initiating
treatment. In hospital-based care, 18/53 hepatitis C patients (34%) commenced treatment at a mean
cost of A$2,197 (range: A$2,127-2,469) per patient initiating treatment – more than twice as high as
primary care.
Conclusion and next steps:
Compared to hospital-based care, providing hepatitis C services in primary care can improve
treatment uptake and reduce the costs of treatment initiation. To improve treatment uptake and
cure, countries should consider primary-based care as the main model for hepatitis C treatment
Disclosure of Interest Statement:
MH, JD and the Burnet Institute receive investigator-initiated research funding from Gilead Sciences,
Merck, AbbVie and Bristol-Myers Squibb (BMS). AT is an advisory board member for Gilead Sciences,
AbbVie, BMS, Merck and Roche Diagnostics, and a speaker for Gilead, Merck, BMS, AbbVie, Roche
Diagnostics. AW has received investigator-initiated research funding from AbbVie. JD has received
honoraria for advisory boards or speaking from Gilead Sciences, AbbVie and Merck. NS has received
investigator-initiated research funding from Gilead Sciences. JH has received an Australia Fellowship
(investigator-initiated project) from Gilead Sciences.

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