HepCATT (Hepatitis C Assessment to Treatment Trial) in primary care: a cluster RCT of whether a complex intervention based on risk prediction algorithm tool and education can increase testing and diagnosis of HCV in primary care
Abstract
Background:
In many European countries the majority of HCV infections are in people with an injecting history. We evaluate a complex intervention in primary care that aims to increase uptake of HCV case-finding and treatment.
Methods
Cluster RCT of 45 practises to test whether a complex intervention based on risk prediction algorithm tool and education can increase testing and diagnosis of HCV in primary care – with nested qualitative study and economic evaluation. HCV testing was provided opportunistically through pop-ups and by sending out screening invitation letters and follow-ups. Control practices followed usual care.
Results:
Information on patients with HCV risk markers linked to PHE laboratory data was collected successfully from 22 intervention practices and 21 control practices. A total of 21,847 “high risk” patients were identified (11,407 in intervention and 10,440 in control practices). There was strong evidence that the intervention increased HCV case-finding (13% vs 8.35%; Risk Ratio 1.59 95%CI 1.12-2.26 p=0.01); and increased referral and assessment for HCV treatment (32.6% vs 11%). A nested qualitative study found that participating health care professionals increased knowledge and awareness on HCV and valued the intervention. The additional cost of case finding per at risk patient in the intervention practices was £7.10 (£4.75 to £9.45) or £4.03 (£2.27 to £5.80) excluding installation costs. The average cost per additional patient referred to hepatology for treatment was from £3,200 to £5,600. The base case results produced an Incremental Cost Effectiveness Ratio (ICER) of £7,507 per QALY with 89.7% probability of cost-effectiveness at £20,000 per QALY.
Conclusion and next steps:
HepCATT primary care intervention is acceptable and can lead to modest increase in HCV case-finding and is strongly cost-effective. HepCATT should be implemented across primary care and additional interventions developed to increase its impact.