Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care

Abstract

ObjectiveTo evaluate the effectiveness and cost effectiveness of a complex intervention in primary care that aims to increase uptake of hepatitis C virus (HCV) case finding and treatment.DesignPragmatic, two armed, practice level, cluster randomised controlled trial and economic evaluation.Setting and participants45 general practices in South West England (22 randomised to intervention and 23 to control arm). Outcome data were collected from all intervention practices and 21/23 control practices. Total number of flagged patients was 24 473 (about 5% of practice list).InterventionElectronic algorithm and flag on practice systems identifying patients with HCV risk markers (such as history of opioid dependence or HCV tests with no evidence of referral to hepatology), staff educational training in HCV, and practice posters/leaflets to increase patients’ awareness. Flagged patients were invited by letter for an HCV test (with one follow-up) and had on-screen pop-ups to encourage opportunistic testing. The intervention lasted one year, with practices recruited April to December 2016.Main outcome measuresPrimary outcome: uptake of HCV testing. Secondary outcomes: number of positive HCV tests and yield (proportion HCV positive); HCV treatment assessment at hepatology; cost effectiveness.ResultsBaseline HCV testing of flagged patients (six months before study start) was 608/13 097 (4.6%) in intervention practices and 380/11 376 (3.3%) in control practices. During the study 2071 (16%) of flagged patients in the intervention practices and 1163 (10%) in control practices were tested for HCV: overall intervention effect as an adjusted rate ratio of 1.59 (95% confidence interval 1.21 to 2.08; P<0.001). HCV antibodies were detected in 129 patients from intervention practices and 51 patients from control practices (adjusted rate ratio 2.24, 1.47 to 3.42) with weak evidence of an increase in yield (6.2% v 4.4%; adjusted risk ratio 1.40, 0.99 to 1.95). Referral and assessment increased in intervention practices compared with control practices (adjusted rate ratio 5.78, 1.6 to 21.6) with a risk difference of 1.3 per 1000 and a “number needed to help” of one extra HCV diagnosis, referral, and assessment per 792 (95% confidence interval 558 to 1883) patients flagged. The average cost of HCV case finding was £4.03 (95% confidence interval £2.27 to £5.80) per at risk patient and £3165 per additional patient assessed at hepatology. The incremental cost effectiveness ratio was £6212 per quality adjusted life year (QALY), with 92.5% probability of being below £20 000 per QALY.ConclusionHepCATT had a modest impact but is a low cost intervention that merits optimisation and implementation as part of an NHS strategy to increase HCV testing and treatment.Trial registrationISRCTN61788850.

Increasing uptake of hepatitis C virus infection case-finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial

“…During the trial, 2071 (16%) of patients identified in the intervention practices and 1163 (10%) in the control practices were tested for HCV, giving an overall intervention effect as an adjusted risk ratio of 1.59 (95% CI = 1.21 to 2.08, P<0.001). 15 Intervention practices had a greater yield of positive antibody tests compared with control practices (6.2% versus 4.2%; rate ratio 1.42; 95% CI = 0.95 to 2.13), and the intervention was demonstrated to be highly cost-effective for the NHS. 15 Recommendations have been made by the trial team to implement the HepCATT intervention across the UK.…”

“…15 Intervention practices had a greater yield of positive antibody tests compared with control practices (6.2% versus 4.2%; rate ratio 1.42; 95% CI = 0.95 to 2.13), and the intervention was demonstrated to be highly cost-effective for the NHS. 15 Recommendations have been made by the trial team to implement the HepCATT intervention across the UK.…”

“…HepCATT trial findings demonstrated an effective and cost-effective intervention. 15 Although the effect size was modest, the intervention is very low cost to implement. Previous research has suggested that a high proportion of patients at risk of HCV are not being tested in primary care as a result of clinicians not remembering to test patients with risk factors, and not being able to quickly and reliably determine HCV risk and status from EMIS coding.…”

Provider‐related barriers and enablers to the provision of hepatitis C treatment by general practitioners in Scotland: A behaviour change analysis

“…Expanding the role of GPs in relation to HCV treatment aims to capitalize on interventions designed to systematically identify and test individuals in primary care, closing gaps in the care cascade. For example, the HepCATT study in England demonstrated the effectiveness of a low‐cost intervention (which included key education/training elements) to increase HCV diagnoses in general practice 25,26 . However, the model relied on subsequent engagement with specialist services to translate this into improved treatment numbers.…”

Current international guidelines for the management of patients with chronic viral hepatitis C

“…Болезнь поражает большое число лиц молодого и трудоспособного возраста [2], сопровождается длительным стертым течением с возможным развитием фиброза, цирроза печени и гепатоцеллюлярной карциномы (ГЦК) [3,4]. Все это неизбежно ведет к росту инвалидизации, смертности населения [5] и к увеличению государственных экономических потерь [6]. В этой связи научные медицинские сообщества уделяют огромное внимание исследованиям в этой области.…”