Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study
| Autor: | Bryce D. Smith, Joanne E. Brady, Claudia Vellozzi, Danielle K. Liffmann, Joseph L. Kannry, Cynthia Jordan, Kimberly A. Brown, David B. Rein, David R. Nerenz, Natalie Kil, Anthony Yartel, Omar Massoud, Alex D. Federman |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Cost effectiveness Psychological intervention Hepacivirus Article law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans Mass Screening Serologic Tests 030212 general & internal medicine Mass screening Aged Randomized Controlled Trials as Topic Hepatology business.industry Hepatitis C Health Care Costs Hepatitis C Antibodies Middle Aged medicine.disease Confidence interval Relative risk 030211 gastroenterology & hepatology Female business Cohort study |
| Zdroj: | Hepatology (Baltimore, Md.). 65(1) |
| ISSN: | 1527-3350 |
| Popis: | Background: From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. Rationale: To estimate the effects of interventions conducted as part of the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C study on hepatitis C virus (HCV) testing and costs among persons of the 1945-1965 birth-cohort (BC). Main Results: Intervention resulted in substantially higher HCV testing rates compared to standard-of-care (26.9% vs. 1.4% for repeated-mailing, 30.9% vs. 3.6% for BPA, and 63.5% vs. 2.0% for patient-solicitation), and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% Confidence Interval (CI) 9.7-38.2] for repeated-mailing, 13.2 [95% CI 3.6-48.6] for BPA, and 32.9 [95% CI 19.3-56.1] for patient-solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1,691). Conclusion: HCV testing interventions resulted in an increase in BC testing compared to standard-of-care but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared to the other interventions. This article is protected by copyright. All rights reserved. |
| Databáze: | OpenAIRE |
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