Cost of hepatitis C care facilitation for HIV/hepatitis C co-infected people who use drugs.

Using data from a randomized trial (CTN-0064, “Linkage to Hepatitis C Virus (HCV) Care Among HIV/HCV Co-Infected Substance Users”), researchers evaluated the cost of HCV care facilitation that supports moving along the continuum of care for HIV/HCV co-infected individuals with substance use disorder.

Participants were HIV patients residing in the community, initially recruited from eight US hospital sites. They received HCV care facilitation (n = 51) or treatment as usual (n = 62) for up to six months. Researchers used micro-costing methods to evaluate costs from the healthcare sector and patient perspectives in 2017 USD, conducted sensitivity analyses varying care facilitator caseloads, and examined offsetting savings using participant self-reported healthcare utilization.

The average site start-up cost was $6320 (site range: $4320-$7000), primarily consisting of training. The mean weekly cost per participant was $20 (site range: $4-$30) for care facilitation visits and contacts, $360 (site range: $130- $700) for supervision and client outreach, and $70 (site range: $20-$180) for overhead. In sensitivity analyses applying a weekly caseload of 10 participants per care facilitator (versus 1–6 observed in the trial), the total mean weekly care facilitation cost from the healthcare sector perspective decreased to $110. Weekly participant time and travel costs averaged $7. There were no significant differences in other healthcare service costs between participants in the intervention and control arms.

Conclusions: Weekly HCV care facilitation costs were approximately $450 per participant, but approximately $110 at a real-world setting maximum caseload of 10 participants per week. No healthcare cost offsets were identified during the trial period, although future savings might result from successful HCV treatment.

Related protocols: CTN-0064