title: Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study.
abstract: From December 2012 to March 2014, three randomized trials, each implementing a unique intervention in primary care settings (repeated mailing, an electronic health record best practice alert [BPA], and patient solicitation), evaluated hepatitis C virus (HCV) antibody testing, diagnosis, and costs for each of the interventions compared with standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. The goal of this study was to estimate the effects of interventions conducted as part of the Birth-Cohort Evaluation to Advance Screening and Testing for Hepatitis C study on HCV testing and costs among persons of the 1945-1965 birth cohort (BC). Intervention resulted in substantially higher HCV testing rates compared with standard-of-care testing (26.9% versus 1.4% for repeated mailing, 30.9% versus 3.6% for BPA, and 63.5% versus 2.0% for patient solicitation) and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% confidence interval (CI), 9.7-38.2] for repeated mailing, 13.2 [95% CI, 3.6-48.6] for BPA, and 32.9 [95% CI, 19.3-56.1] for patient solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1691).
  
  
  
  HCV testing interventions resulted in an increase in BC testing compared with standard-of-care testing but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared with the other interventions. (Hepatology 2017;65:44-53).
authors: NORC at the University of Chicago, Public Health Department, Bethesda, MD.
authors: Joanne E
authors: JE
authors: Brady
authors: The Chartis Group, Chicago, IL.
authors: Danielle K
authors: DK
authors: Liffmann
authors: Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA.
authors: Anthony
authors: A
authors: Yartel
authors: Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Natalie
authors: N
authors: Kil
authors: Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Alex D
authors: AD
authors: Federman
authors: Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Joseph
authors: J
authors: Kannry
authors: University of Alabama at Birmingham, Department of Medicine, Birmingham, AL.
authors: Cynthia
authors: C
authors: Jordan
authors: University of Alabama at Birmingham, Department of Medicine, Birmingham, AL.
authors: Omar I
authors: OI
authors: Massoud
authors: Center for Health Policy and Health Services Research, Henry Ford Hospital, Detroit, MI.
authors: David R
authors: DR
authors: Nerenz
authors: Division of Gastroenterology, Department of Medicine, Henry Ford Hospital, Detroit, MI.
authors: Kimberly A
authors: KA
authors: Brown
authors: Division of Diabetes Translation, U.S. Centers for Disease Control and Prevention, Atlanta, GA.
authors: Bryce D
authors: BD
authors: Smith
authors: Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, GA.
authors: Claudia
authors: C
authors: Vellozzi
authors: NORC at the University of Chicago, Public Health Department, Bethesda, MD.
authors: David B
authors: DB
authors: Rein
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis* / Q000191:economics*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012698:Serologic Tests / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D018937:Hepatitis C Antibodies