Economic Evaluation of Different Organizational Models for the Management of Patients with Hepatitis C

Stefano Fagiuoli, Luisa Pasulo, Franco Maggiolo, Rosaria Spinella, Paolo Del Poggio, Roberto Boldizzoni, Mariella Di Marco, Alessandro Aronica, Chiara Benedetti, Paolo Correale, Chiara Garavaglia, Carlo Nicora

DOI: https://doi.org/10.7175/fe.v20i1.1374

Abstract

BACKGROUND: Access to Directly Acting Antivirals (DAAs) for Hepatitis C Virus (HCV) treatment in Italy was initially restricted to severe patients. In 2017, AIFA expanded access to all patients, to achieve elimination by 2030.

AIM: To investigate the impact of different hospitals’ organizational models on elimination timing, treatment capacity and direct costs.

METHODS: Most Regional healthcare systems in Italy deploy a Center of Excellence (CoE) organizational model, where patients are referred to a single major hospital in the area, which is the only one that can prescribe and deliver DAAs. The study was conducted at Bergamo’s (Lombardy, Italy) Papa Giovanni XXIII hospital (PG-23), which deploys a Hub&Spoke model: the Hub (PG-23) prescribes and delivers DAAs while Spokes (four smaller hospitals) can only prescribe them. The study compares the two models (CoE vs. H&S). Patient journey and workloads were mapped and quantified through interviews with hospital stakeholders. Cost data were collected through the hospital’s IT system; the sample comprised 2,277 HCV patients, over one year.

RESULTS: The study calculated the average cost to treat HCV patients (~ € 1,470 per patient). Key cost drivers are lab tests (60%) and specialist visits (30%). Over one year, H&S can treat 68% more patients than CoE. As deferred patients absorb up to 40% of total costs, the “Optimized” model was designed by streamlining specialists’ visits and involving general practitioners during follow-up. “Optimized” model increases treatment capacity and reduces costs of deferred patients by 72% vs CoE.

CONCLUSION: The study demonstrates the importance of organizational models in efficiently achieving 2030 elimination.

Keywords

Hepatitis C; Italy; Models, Organizational; Antiviral Agents; DAA; HCV; Hub & Spoke; Center of Excellence

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References

  • World Health Organization. Hepatitis C. Fact sheet. Updated April 2017. Available at http://www.who.int/mediacentre/factsheets/fs164/en/ (last accessed August 2017)
  • World Health Organization. Towards access 2030 – Medicine and Health Products program strategic Framework 2016-2030. Available at http://www.who.int/medicines/publications/towards_access2030/en/ (last accessed August 2017)
  • ISTAT. Le principali cause di morte in Italia. Anno 2012. Available at: https://www.istat.it/it/files/2014/12/Principali_cause_morte_2012.pdf (last accessed July 2017)
  • Wilkins T, Malcolm JK, Raina D, et al. Hepatitis C: diagnosis and treatment. Am Fam Physician 2010; 81: 1351-7
  • Poordad F, McCone J Jr, Bacon BR, et al.; SPRINT-2 Investigators. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med 2011; 364: 1195-206; http://dx.doi.org/10.1056/NEJMoa1010494
  • Lange CM, Jacobson IM, Rice CM, et al. Emerging therapies for the treatment of hepatitis C. EMBO Mol Med 2014; 6: 4-15; http://dx.doi.org/10.1002/emmm.201303131
  • Agenzia Italiana Del Farmaco. Bacheca atti amministrativi regionali. Available at http://www.aifa.gov.it/content/bacheca-atti-amministrativi-regionali (last accessed August 2017)
  • Agenzia Italiana Del Farmaco. Nuovo algoritmo per la terapia dell’epatite C cronica. Available at http://www.agenziafarmaco.gov.it/content/l%E2%80%99aifa-pubblica-il-nuovo-algoritmo-la-terapia-dell%E2%80%99epatite-c-cronica (last accessed December 2017)
  • Regione Lombardia. Approvazione del documento di indirizzo per la gestione del nuovi farmaci antivirali per la terapia dell’epatite C cronica e per l’attivazione della rete regionale HCV. Decreto n. 7826 del 28/09/2015
  • Agenzia Italiana Del Farmaco. Ridefinizione dei criteri di trattamento per la terapia dell’Epatite C cronica. Determina n. 500/2017 del 24/03/2017. GU n.75 del 30-3-2017
  • Kondili LA, Romano F, Rolli FR, et al.; PITER Collaborating Group. Modeling Cost-Effectiveness and Health Gains of a “Universal” Versus “Prioritized” Hepatitis C Virus Treatment Policy in a Real-Life Cohort. Hepatology 2017; 66: 1814-25; http://dx.doi.org/10.1002/hep.29399
  • Agenzia Italiana Del Farmaco. Aggiornamento epatite C. Available at http://www.agenziafarmaco.gov.it/content/aggiornamento-epatite-c (last accessed August 2017)
  • Lanati EP, Lidonnici D, Gasbarrini A, et al. Cohort of HCV patients in Italy: sizing and treatments in a sample of Italian. ISPOR 17th Annual European Congress. Amsterdam: 2014
  • Rizzetto M. Un modello esportabile per l’eliminazione di HCV in Italia. ReAd files 2018; 19: 46-9

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