Australian and New Zealand journal of public health · 2025
Active follow-up of hepatitis C notifications by public health staff improves treatment uptake.
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Sharma Siddhanth, Parker Erica, Farmer Kane, Scalley Benjamin
Аннотация
OBJECTIVE: Improve hepatitis C treatment uptake in Perth, Western Australia, by piloting active follow-up of hepatitis C notifications, and evaluate the cost-effectiveness of this intervention.
METHODS: Hepatitis C cases notified January to December 2023 (n=714) were reviewed. For each case, ribonucleic acid (RNA) testing status and direct-acting antiviral (DAA) treatment commencement status were assessed under the standard of care (pre-intervention baseline). Subsequently, an active follow-up intervention provided direct support to clinicians and patients to actively link patients to RNA testing and/or DAA commencement. Outcomes were then compared pre- and post-intervention, and the cost-benefit was estimated using conservative assumptions.
RESULTS: Active follow-up increased RNA testing rates from 80% to 92% (p<0.01), resulting in an increase from 69% to 80% (p<0.01) of cases appropriately managed (i.e. commenced treatment or confirmed RNA negative). Twenty-two people were assisted to start treatment, costing $3,500 dollars per QALY gained, with a net societal benefit of $151,000.
CONCLUSIONS: Public health units can play an important role in tracking and sustaining momentum towards hepatitis C elimination. Active follow-up of notified cases is highly cost-effective.
IMPLICATIONS FOR PUBLIC HEALTH: Hepatitis C treatment uptake has declined in recent years and remains below levels required for elimination in Australia by 2030. Actively managing notified cases can boost treatment uptake.
METHODS: Hepatitis C cases notified January to December 2023 (n=714) were reviewed. For each case, ribonucleic acid (RNA) testing status and direct-acting antiviral (DAA) treatment commencement status were assessed under the standard of care (pre-intervention baseline). Subsequently, an active follow-up intervention provided direct support to clinicians and patients to actively link patients to RNA testing and/or DAA commencement. Outcomes were then compared pre- and post-intervention, and the cost-benefit was estimated using conservative assumptions.
RESULTS: Active follow-up increased RNA testing rates from 80% to 92% (p<0.01), resulting in an increase from 69% to 80% (p<0.01) of cases appropriately managed (i.e. commenced treatment or confirmed RNA negative). Twenty-two people were assisted to start treatment, costing $3,500 dollars per QALY gained, with a net societal benefit of $151,000.
CONCLUSIONS: Public health units can play an important role in tracking and sustaining momentum towards hepatitis C elimination. Active follow-up of notified cases is highly cost-effective.
IMPLICATIONS FOR PUBLIC HEALTH: Hepatitis C treatment uptake has declined in recent years and remains below levels required for elimination in Australia by 2030. Actively managing notified cases can boost treatment uptake.