Cost of Hepatitis C care facilitation for HIV/Hepatitis C Co-infected people who use drugs

Abstract

Background: Using data from a randomized trial, we evaluated the cost of HCV care facilitation that supports moving along the continuum of care for HIV/HCV co-infected individuals with substance use disorder.

Methods: Participants were HIV patients residing in the community, initially recruited from eight US hospital sites. They received HCV care facilitation (n = 51) or treatment as usual (n = 62) for up to six months. We used micro-costing methods to evaluate costs from the healthcare sector and patient perspectives in 2017 USD. We conducted sensitivity analyses varying care facilitator caseloads and examined offsetting savings using participant self-reported healthcare utilization.

Results: The average site start-up cost was $6320 (site range: $4320-$7000), primarily consisting of training. The mean weekly cost per participant was $20 (site range: $4-$30) for care facilitation visits and contacts, $360 (site range: $130- $700) for supervision and client outreach, and $70 (site range: $20-$180) for overhead. In sensitivity analyses applying a weekly caseload of 10 participants per care facilitator (versus 1-6 observed in the trial), the total mean weekly care facilitation cost from the healthcare sector perspective decreased to $110. Weekly participant time and travel costs averaged $7. There were no significant differences in other healthcare service costs between participants in the intervention and control arms.

Conclusion: Weekly HCV care facilitation costs were approximately $450 per participant, but approximately $110 at a real-world setting maximum caseload of 10 participants per week. No healthcare cost offsets were identified during the trial period, although future savings might result from successful HCV treatment.

Trial registration: ClinicalTrials.gov NCT01612169 NCT02641158.

Keywords: Care facilitation; Cost; HIV; Hepatitis C; Substance use disorder.

Figure 1.. Weekly cost per participant decreased with increasing caseloads.

The mean weekly cost per participant at an average weekly caseload was $450, the mean weekly cost per participant at a peak weekly caseload was $220, and the mean weekly cost per participant at realistic caseload of 10 clients per week was $110. All costs are in 2017 USD. Note: The average weekly caseload was 2 participants per week (site range: 1–6). The average peak weekly caseload was 5 participants per week (site range: 2–12), which represents the peak number of participants at a site in a given week. The sensitivity capacity caseload was 10 participants per week at every site, estimated from site interviews and discussions with the study team.