Integrating Hepatitis C Care for opioid substitution treatment patients attending general practice: Feasibility, Clinical and Cost Effectiveness

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

4C.9

Presenter:

Geoff McCombe

Twitter:

@geoffmccombe

Co-authors:

Davina Swan1, John S. Lambert1,2, Eileen O’Connor1, Zoe Ward3, Peter Vickerman3, Gordana Avramovic1,2, Des Crowley1,4, Willard Tinago1, Nyashadzaishe Mafikureva3, Walter Cullen1

Author institutions:

1University College Dublin, 2Mater Misericordiae University Hospital, Dublin, 3Population Health Sciences, Bristol Medical School, University of Bristol, 4Health Service Executive, Dublin, Ireland

Problem

Hepatitis C (HCV) infection is common among people who inject drugs (PWID). It is estimated that 10 million PWID globally and 0.7 million PWID in Europe have been infected with HCV. Despite the high prevalence among PWID, well described barriers mean many are unaware of their infection and few have received treatment for the infection. In Ireland, injecting drug use is the primary risk factor in 80% of cases. Previous research in Dublin found 77% of patients on opioid substitution treatment (OST) in general practices had been screened for HCV, and of those who were HCV antibody-positive, just 35% had received follow-up HCV-RNA testing, 30% had been referred to a hepatology clinic, and only 3% had initiated HCV treatment. The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice in Dublin, Ireland.

Approach

A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The complex intervention comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions.

Findings

Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention on 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of who had a liver fibroscan (17/101(16.8%) vs 52/100 (52.0%); p<0.001), had attended hepatology/infectious diseases services (51/101(50.5%) vs 61/100 (61.0%); p=0.002), and initiated treatment (20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%.

Consequences

The complex intervention involving clinical support, access to assessment and practitioner education has the potential to enhance patient care, improving access to assessment and treatment in a cost effective manner. The study findings enhance the scientific understanding of interventions that contribute to health and social gain and can inform national policy and service development. The authors are actively engaged with key stakeholders and policy-makers to ensure that the project contributes to policy and practice.

Submitted by:

Geoff McCombe

Funding acknowledgement:

The European Commission who funded project through its Third Health Programme (Grant Agreement Number 709844) and Ireland’s Health Services Executive.