Clinical and economic impact of an alert system in primary care for the detection of patients with chronic hepatitis C

• Published in: PloS one 2021-12, Vol.16 (12), p.e0260608-e0260608
• Main Authors: García-Herola, Antonio, Domínguez-Hernández, Raquel, Casado, Miguel Ángel
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Asymptomatic; Biology and life sciences; Care and treatment; Cirrhosis; Complications; Computer and Information Sciences; Costs; Decision making; Decision trees; Diagnosis; Economic impact; Electronic Health Records; Electronic medical records; Epidemiology; Evaluation; Health care; Health Care Costs; Hepatitis; Hepatitis C; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - pathology; Hepatocellular carcinoma; Humans; Impact analysis; Infections; Liver; Liver cancer; Liver cirrhosis; Liver Diseases - etiology; Liver Diseases - mortality; Liver transplantation; Liver transplants; Markov Chains; Materials selection; Medical care; Medicine and Health Sciences; Middle Aged; Mortality; Patients; Performance evaluation; Pharmacoeconomics; Population; Primary care; Primary health care; Primary Health Care - economics; Primary Health Care - methods; Public health; Quality management; Quality-Adjusted Life Years; Serology; Severity of Illness Index; Social Sciences; Spain; Survival Analysis; Transplants; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0260608

Prevalence of chronic hepatitis C (CHC) is higher in patients born between 1955-1975. The aim was to perform an economic evaluation of an age-based electronic health record (EHR) alert in primary care to detect patients with undiagnosed CHC and its treatment in comparison with non-use of the alert system, in Valencian Community, Spain. Decision trees and Markov model were used to evaluate the diagnosis and progression of the disease, respectively. CHC was diagnosed by serology and viral load in seropositive subjects. Epidemiological data and diagnostic costs were extracted from public sources of the Valencian Community. Probabilities, utilities and costs of model states were obtained from the literature. The impact on mortality and hepatic complications avoided by the implementation of the alert were estimated, and efficiency was measured as an incremental cost-utility ratio (ICUR) based on quality-adjusted life years (QALYs) and the costs of both alternatives. The EHR alert detected 269,548 patients, of whom 1,331 had CHC (vs. 23 patients with non-alert). Over the patients' lifetime, the alert would prevent 93% of decompensated cirrhosis cases, 87% of hepatocellular carcinomas, 90% of liver transplants, and 89% of liver related deaths compared to non-use of the alert system. In addition, it would obtain an additional 3.3 QALY per patient, with an incremental cost of €10,880 and an ICUR of €3,321. The implementation of an age-based EHR alert in primary care to detect patients with CHC reduces hepatic complications and mortality and is an efficient strategy.