School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan; Medical School, University of Münster, Münster, Germany.
School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan; Ross School of Business, University of Michigan, Ann Arbor, Michigan.
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.
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.
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.
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.
慢性丙型肝炎病毒（HCV）感染给个人和医疗保健系统带来了沉重负担。社区医疗保健成果扩展项目（Project ECHO）使初级保健提供者能够为服务不足的人群提供最佳实践的复杂疾病护理。美国国会于 2016 年底通过了 ECHO 法案，要求卫生与公众服务部对该模式进行调查。我们进行了一项成本效益分析，以评估在实施和不实施 Project ECHO 的情况下，对初级保健患者群体进行 HCV 感染诊断和治疗的效果。
我们使用马尔可夫模型来模拟 HCV 感染个体和一般人群的疾病进展、生活质量和预期寿命。来自新墨西哥大学 ECHO 运营的 HCV 数据显示治疗率有所增加。然后，比较了 ECHO 和非 ECHO HCV 患者之间在生存、质量调整生命年（QALYs）、成本和由此产生的预算影响方面的相应增加。
Project ECHO 增加了成本和 QALYs。与现状相比，ECHO 的增量成本效益比为每 QALY 10351 美元；超过 99.9%的迭代低于每 QALY 100000 美元的支付意愿阈值。我们无法确定与 Project ECHO 相关的治疗率增加是由于增加了还是更有针对性的筛查、更高的依从性或获得治疗的机会。我们的敏感性分析表明，结果在很大程度上独立于原因。预算影响分析表明，在 5 年内，为了增加 4446 名患者的治疗，每 100 万参保人数，支付方将不得不额外投资 3395.4 万美元。
使用模拟的初级保健患者群体，我们表明 Project ECHO 是一种通过现有初级保健提供者大规模发现和治疗 HCV 感染患者的具有成本效益的方法。这种方法可以大大减轻美国慢性 HCV 感染的负担，但高预算成本表明，ECHO 的增量推出可能是最佳选择。
