HEPCARE EUROPE- A case study of a service innovation project aiming at improving the elimination of HCV in vulnerable populations in four European cities. (December 2020) - Avramovic, Gordana
Highlights: An integrated system of care for HCV is effective to access vulnerable populations. An integrated system of care greatly improves the cascade of care for HCV, including cure. An integrated system of HCV care is cost effective. An integrated system of HCV care is replicable in four European countries, informing reproducibility and scale-up. Abstract: Objectives: Hepatitis C Virus (HCV) is a significant cause of chronic liver disease. Among at-risk populations, access to diagnosis and treatment is challenging. We describe an integrated model of care, Hepcare Europe, developed to address this challenge. Methods: Using a case-study approach, we describe the cascade of care outcomes at all sites. Cost analyses estimated the cost per person screened and linked to care. Results: A total of 2608 participants were recruited across 218 clinical sites. HCV antibody test results were obtained for 2568(985%); 1074(418%) were antibody-positive, 687(605%) tested positive for HCV-RNA, 650(605%) were linked to care, and 319(435%) started treatment. 196(614%) of treatment initiates achieved a Sustained Viral Response (SVR) at dataset closure, 108(339%) were still on treatment, eight (27%) defaulted from treatment, and seven (26%) had virologic failure or died. The cost per person screened varied from €194 to €635, while the cost per person linked to care varied from €364 to €2035. Conclusions: Hepcare enhanced access to HCV treatment and cure, and costs were affordable in all settings, offering a framework for scale-up and reproducibility.