Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the ...Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United States.Task shifting—whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians—achieves non-inferior treatment outcomes with second generation direct-acting antivirals(2^(nd)Gen DAAs),may increase treatment capacity,and may facilitate greater treatment access.We determined the cost effectiveness of 2^(nd)Gen DAAs with respect to interferon-based first-generation DAAs(1^(st)Gen DAAs)within a task-shifted treatment model.Methods:Using a previously described decision-analytic Markov structure,we modeled a hypothetical cohort of 1,000 patients with HCV genotype 1 infection over a lifetime horizon,based upon our outreach clinic's HCV treatment protocol.Treatment-naive and treatment-experienced HCV cohorts were modeled separately,based upon our outr8each clinic's demographics.Treatment response to 2^(nd)Gen DAAs was modeled based on our outreach clinic's data.Adverse events,utility,costing,and transition probabilities were sourced from the literature.Results:Driven by improved effectiveness and safety,as well as an expected increase in treatment capacity,2^(nd)Gen DAAs treatment monitored by non-physician clinicians was projected to improve health outcomes and be dominant from a cost-effective perspective versus that of 1^(st)Gen DAAs.Trends were consistent across all assessed patient subpopulations.Conclusions:Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model,2^(nd)Gen DAAs-based treatment was cost effective and cost saving as compared to 1^(st)Gen DAAs-based treatment for all HCV patient subgroups assessed.展开更多
文摘Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United States.Task shifting—whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians—achieves non-inferior treatment outcomes with second generation direct-acting antivirals(2^(nd)Gen DAAs),may increase treatment capacity,and may facilitate greater treatment access.We determined the cost effectiveness of 2^(nd)Gen DAAs with respect to interferon-based first-generation DAAs(1^(st)Gen DAAs)within a task-shifted treatment model.Methods:Using a previously described decision-analytic Markov structure,we modeled a hypothetical cohort of 1,000 patients with HCV genotype 1 infection over a lifetime horizon,based upon our outreach clinic's HCV treatment protocol.Treatment-naive and treatment-experienced HCV cohorts were modeled separately,based upon our outr8each clinic's demographics.Treatment response to 2^(nd)Gen DAAs was modeled based on our outreach clinic's data.Adverse events,utility,costing,and transition probabilities were sourced from the literature.Results:Driven by improved effectiveness and safety,as well as an expected increase in treatment capacity,2^(nd)Gen DAAs treatment monitored by non-physician clinicians was projected to improve health outcomes and be dominant from a cost-effective perspective versus that of 1^(st)Gen DAAs.Trends were consistent across all assessed patient subpopulations.Conclusions:Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model,2^(nd)Gen DAAs-based treatment was cost effective and cost saving as compared to 1^(st)Gen DAAs-based treatment for all HCV patient subgroups assessed.
