Cost and time savings from a rapid access model of care using transient elastography to screen and triage patients with chronic Hepatitis C infection

Figures & data

Table 1. Resources and unit costs included in the analysis.

Resource	Unit cost (2012 AU$)	Source
Both cohorts
Medical review (specialist) 1st visit	519.0	Queensland ABF model Tier 2 Clinic item 20.269,10
Medical review (specialist) 2nd visit +	493.0	Queensland ABF model Tier 2 Clinic item 20.269,10
Medical review (nurse)	236.0	Queensland ABF model Tier 2 Clinic item 40.439,10
Psychiatric review	409.0	Queensland ABF model Tier 2 Clinic item 20.459,10
Allied health review*	236.0	Queensland ABF model Tier 2 Clinic item 40.439,10
Conventional with LB cohort
Episode of care for LB	Patient specific	Transition II Clinical Costing System (Qld Health)
RAAT cohort
Episode of care for TE	Patient specific	Transition II Clinical Costing System (Qld Health)
RAAT clinic establishment and training costs	46.0/hour	Level 6 Nurse Qld Health
TE equipment capital cost	170,000	Qld Health

ABF, Activity Based Framework; AU$, Australian dollars; LB, Liver Biopsy; Qld, Queensland; RAAT, Rapid Access to Assessment and Treatment; TE, Transient Elastography.

*Includes dietician visits.

Table 2. Characteristics of the conventional with LB and RAAT cohorts.

	Conventional with LB^b (n = 13)	RAAT^b (n = 27)	p Value
Age (years)	49.7 ± 6.5	49.2 ± 6.8	0.828
Male (n)	8 (62%)	16 (60%)	0.892
HCV chronicity (months)	20.6 ± 8.1	20.6 ± 12.5	0.958
BMI	23.8 ± 3.6	26.3 ± 4.6	0.180
HCV genotype			0.548
1	5 (38%)	14(56%)
2	0 (0%)	1 (4%)
3	8 (62%)	10 (40%)
Viral load	6.2 ± 1.0	6.1 ± 0.7	0.475
Potential modes of acquisition^a
IVDU	10 (77%)	12 (44%)
Tattoo	5 (38%)	12 (44%)
Transfusion	2 (15%)	1 (4%)
Sexual	1 (8%)	4 (15%)
Other/unknown	2 (15%)	5 (18%)
Smoking history			0.643
None	1 (8%)	4 (16%)
Current/Ex	12 (92%)	21 (84%)
Alcohol history			1.000
None	2 (15%)	5 (20%)
Current/Ex	11 (85%)	20 (80%)
Psychiatric history			1.000
None	7 (64%)	15 (60%)
Yes	4 (36%)	10 (40%)

BMI, Body Mass Index; IVDU, Intravenous Drug Use; HCV, Hepatitis C Virus; n, Number; RAAT, Rapid Access to Assessment and Treatment.

Data are mean or count ± standard deviation or proportion (%).

^aSome patients have more than one answer, hence total exceeds 100%.

^bProportions reported are based on valid cases (i.e., excluding cases with missing data).

Table 3. Mean and median time and cost per patient for the conventional with LB and RAAT cohorts.

	Conventional with LB (n = 13)	RAAT (n = 27)	p Value
Healthcare cost between first review and treatment plan, excluding screening test (2012 AU$)	3612 ± 2066 3157 (2234, 4400)	1810 ± 580 1720 (1248, 2066)	< 0.001
Screening test cost (2012 AU$), including:	2210 ± 1100 2050 (1632, 2188)	972 ± 407 788 (739, 887)	<0.001
TE equipment^a	N/A	39
RAAT establishment^b	N/A	10
Total cost, healthcare + screening (2012 AU$)	5822 ± 2447 5005 (3790, 7076)	2782 ± 565 2716 (2371, 3116)	<0.001
Time to screening test (days)	259 ± 234 164 (109, 394)	57 ± 50 45 (31, 62)	0.004
Time to treatment plan (days)	530 ± 340 420 (290, 765)	200 ± 72 194 (153, 236)	<0.001

AU$, Australian dollars; LB, Liver Biopsy; n, number; RAAT, Rapid Access to Assessment and Treatment; TE, Transient Elastography.

Data are mean ± standard deviation (median: 25th, 75th percentile); rounded to nearest dollar; N/A = not applicable.

^aConsisting of TE equipment ($170,000) annuitized at 5% interest rate over 5 year period, no residual value, assuming TE utilized for 1000 patient episodes annually.

^bConsisting of 0.5 Full Time Equivalent Level 6 Nurse (975 hours × $46/hour = $44,850) annuitized at 5% interest rate over 5 year period, no residual value, assuming RAAT clinic utilized for 1000 patient episodes annually.

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