Underserved HCV patients benefiting from telemedicine

Primary care physicians can provide cost-effective treatment for hepatitis C virus (HCV) infections to underserved populations, according to a new study.

Congress passed the ECHO Act in late 2016, requiring the U.S. Department of Health and Human Services to investigate the Extension for Community Healthcare Outcomes (Project ECHO) to enable primary care providers to deliver best-practice care for complex conditions to underserved populations, using telemedicine.

“We already know that HCV treatment can be cost-effective. Our research adds that ECHO basically enhances the ability of primary care providers to better deliver more care to underserved populations that is cost-effective,” senior author David Hutton, PhD, associate professor of health management and policy at University of Michigan School of Public Health, told Medical Economics.

Project ECHO has already been shown to increase treatment rates for HCV infection in New Mexico. Also, the ECHO model of telehealth/telementoring has expanded nationally to other conditions, including HIV, substance use disorders, diabetes and endocrinology, chronic pain, tuberculosis, autism and palliative care.

The researchers published their results online October 23, 2017, in Gastroenterology.

Next: Study details

They used models to simulate disease progression, quality of life and life expectancy among individuals with HCV infection and for the general population. They found some substantial costs to set up systems like this-payers would have to invest an additional $339.54 million over a five-year period to increase treatment by 4,446 patients, per 1 million covered lives.

The incremental cost-effectiveness ratio of ECHO was $10,351 per quality-adjusted life years compared with the status quo. It’s unknown whether the increase in rates was due to increased or more targeted screening, higher adherence, or access to treatment.

However, expanding HCV treatment access by using the ECHO model can be cost-effective. “With new, lower-cost medications, ECHO could become a cost-saving public health intervention,” said Hutton.

Expanding this type of model involves investment in new infrastructure, training and new spending on all the additional patients who will receive treatment.

“We conducted this analysis to determine if financing this additional investment is worth the cost. We think government, private insurance and health system policy makers are interested in understanding how valuable these investments are,” he said. “That’s why we feel the results of this analysis may help encourage this type of investment. With that in mind, it may take time to roll out new hubs and spokes for Project ECHO.”

A value-based payments system may incentivize systems to engage in innovate approaches to expanding HCV care. “We have shown that the Project ECHO model to expanding care is a financially worthwhile one that could successfully reward implementers under a properly structured value-based system of payments,” said Hutton.

He concluded: “Projects like this do not need researchers, but invested primary care clinicians who are willing to try out something new and engage with new models of care delivery, such as Project ECHO. Without the many clinicians in the field willing to go the extra mile for their patients, Project ECHO would never have worked.”