Cost-Effectiveness of Access Expansion to Treatment of Hepatitis C Virus Infection Through Primary Care Providers

Gastroenterology. 2017 Dec;153(6):1531-1543.e2. doi: 10.1053/j.gastro.2017.10.016. Epub 2017 Oct 23.


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.

Keywords: Community Health Services; Health Care Costs; Incremental Cost-Effectiveness Ratio; Telementoring; Willingness-to-Pay.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Budgets
  • Computer Simulation
  • Cost-Benefit Analysis
  • Decision Trees
  • Female
  • Health Care Costs*
  • Health Services Accessibility / economics*
  • Health Services Accessibility / organization & administration
  • Hepatitis C, Chronic / diagnosis
  • Hepatitis C, Chronic / economics*
  • Hepatitis C, Chronic / therapy*
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Models, Economic
  • New Mexico
  • Patient Care Team / economics
  • Physicians, Primary Care / economics*
  • Physicians, Primary Care / organization & administration
  • Primary Health Care / economics*
  • Primary Health Care / organization & administration
  • Process Assessment, Health Care / economics*
  • Quality-Adjusted Life Years
  • Time Factors
  • Treatment Outcome
  • Young Adult