Comparison of costs of different screening and linkage to care interventions across Europe
Abstract
Background: Hepatitis C Virus (HCV) is a blood borne virus mainly transmitted through injecting drug use in European settings. With World Health Organization targets for elimination of HCV by 2030, countries across Europe have been piloting various interventions to increase the screening and linkage to care of populations with high prevalence, such as prisoners, individuals on opioid substitution therapy (OST), and homeless people. This study aims to compare the costs per person screened, diagnosed/identified, and linked to care for various pilot interventions undertaken as part of the HepCare Europe programme.
Methods:
Four interventions were costed: 1. Nurse liaison for GP prescribers of OST in Dublin, including fibroscan of possible chronic infected cases and linkage to HCV treatment in hospital (HepLink Dublin); 2. Nurse led mobile outreach in London targeting homeless populations and people who inject drugs, with peer support for linkage to HCV treatment in hospital (HepFriend London); 3. Mass opt-out screening in a Dublin prison with a peer based awareness program, including linkage to prison-based treatment (HepCheck Dublin); and 4. Screening and linkage to care in targeted high-risk settings in Bucharest including night shelters for the homeless (HepCare Bucharest). For each site, intervention costs were collected by interview with intervention staff using a top down approach, including staff costs, resource use and HCV test costs. Setup costs were annualised over 5 years for all interventions. The cost per person screened, diagnosed and linked to care was calculated for each intervention.
Results: The costs per year were €121,154, €142,837, €81,415, and €16,340 for HepLink Dublin, HepFriend London, HepCheck Dublin, and HepCare Bucharest, respectively. The cost per patient outcome was effected by the size of the target population reached and the prevalence of HCV in each setting (Table 1). The HepFriend London intervention also had a peer support component helping patients attend hospital appointments and adhere to treatment which cost an additional €775 per patient treated (n=44).
Table 1: Comparison of costs per patient by intervention setting
Screened
Diagnosed/identified
Linked to care
Intervention
N
Unit Cost
N
Unit Cost
N
Unit Cost
HepLink Dublin
102
€1187
57
€2125
43
€2817
HepFriend London
273
€248
121
€558
110
€1171
HepCheck Dublin
419
€190
50
€1588
40
€1893
HepCare Bucharest
163
€63
9
€1140
4
€2565
Conclusion: Across four different settings, the cost of HCV screening interventions per person screened differed by 18-fold between the interventions with the highest (HepLink Dublin) and lowest (HepCare Bucharest) cost. However, the resulting cost per patient linked to care was more similar, with only a 2.4-fold difference between the highest (HepLink Dublin) and lowest (HepFriend London) intervention. Our results highlight that the implementation of similar interventions in different European settings can have very different costs, while the subsequent efficiency will also depend on the yield and degree to which individuals are linked to care.