Cost Effectiveness of Rapid Access to Assessment and Treatment Model of Care:
Targeted Hepatitis C Clinics
Background: One of the key pillars of the Commonwealth Governments 3 rd National
Hepatitis C Virus (HCV) strategy is to improve patient access to antiviral treatment
(AVT). The Rapid Access to Assessment and Treatment (RAAT) model of care
involves streamlining HCV patients with mild fibrosis to dedicated clinics where they
are assessed by a consultant hepatologist followed by subsequent investigations
including standard laboratory tests, abdominal ultrasound and transient elastography
(TE).
Aims and Methods: The study compared the efficiency of the RAAT model of care
to historical HCV controls treated in a General Liver Clinic (GLC) in treatment of
patients with chronic HCV infection. We conducted a retrospective review of 13
HCV patients first seen in general Hepatology clinics in 2008 who had a liver biopsy.
These historical HCV patients were matched for age, gender and fibrosis stage with
28 HCV patients treated in 2012 under the RAAT model. Patient demographics,
clinical and laboratory data were collected from patient medical records. The median
number of patient attendances from first medical visit to initiation of AVT and the
time to treatment in days was analysed.
Results: The mean (+SD) age was 49.5+6.6, 60.9% were male and 49% were
Genotype 1 and 51% were Genotypes 2/3. There was no significant difference
between the two cohorts in terms of requirement for psychology review or treatment
prior to AVT (38.5% GLC vs. 35.7%RAAT), fibrosis stage on liver biopsy or TE and
presence of other co-morbidities. Cirrhosis was found in 7% in both groups and 93%
of the patients were treatment naïve.
General Liver Clinic
RAAT
p value
(n =13)
(n=28)
5 (1-12)
2 (2-4)
0.001
Median number of
medical visits before
initiation of AVT (range)
603.4
189.6
<0.0001
Time from initial visit to
initiation of AVT (day)
RAAT model of care resulted in a significant reduction in time to commencement of
AVT with fewer medical visits.
Conclusions: The RAAT model of care results in a significant decrease in number of
visits and time to initiation of AVT. In time, this is likely to result in improved access
to AVT for HCV patients. The efficiency of the RAAT model of care is likely to
result in significant cost savings. Cost-analysis studies are required to confirm the cost
effectiveness of the RAAT model.