Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care

Roberts, Kirsty; Macleod, John; Metcalfe, Chris; Hollingworth, Will; Williams, Jack; Muir, Peter; Vickerman, Peter; Clement, Clare; Gordon, Fiona; Irving, Will; Waldron, Cherry Ann; North, Paul; Moore, Philippa; Simmons, Ruth; Miners, Alec; Horwood, Jeremy; Hickman, Matthew

Abstract

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. OBJECTIVE: To evaluate the effectiveness and cost effectiveness of a complex intervention in primary care that aims to increase uptake of hepatitis C virus (HCV) case finding and treatment. DESIGN: Pragmatic, two armed, practice level, cluster randomised controlled trial and economic evaluation. SETTING AND PARTICIPANTS: 45 general practices in South West England (22 randomised to intervention and 23 to control arm). Outcome data were collected from all intervention practices and 21/23 control practices. Total number of flagged patients was 24?473 (about 5% of practice list). INTERVENTION: Electronic algorithm and flag on practice systems identifying patients with HCV risk markers (such as history of opioid dependence or HCV tests with no evidence of referral to hepatology), staff educational training in HCV, and practice posters/leaflets to increase patients' awareness. Flagged patients were invited by letter for an HCV test (with one follow-up) and had on-screen pop-ups to encourage opportunistic testing. The intervention lasted one year, with practices recruited April to December 2016. MAIN OUTCOME MEASURES: Primary outcome: uptake of HCV testing. SECONDARY OUTCOMES: number of positive HCV tests and yield (proportion HCV positive); HCV treatment assessment at hepatology; cost effectiveness. RESULTS: Baseline HCV testing of flagged patients (six months before study start) was 608/13?097 (4.6%) in intervention practices and 380/11?376 (3.3%) in control practices. During the study 2071 (16%) of flagged patients in the intervention practices and 1163 (10%) in control practices were tested for HCV: overall intervention effect as an adjusted rate ratio of 1.59 (95% confidence interval 1.21 to 2.08; P

Citation

Roberts, K., Macleod, J., Metcalfe, C., Hollingworth, W., Williams, J., Muir, P., …Hickman, M. (2020). Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care. BMJ, 368(368), Article m322. https://doi.org/10.1136/bmj.m322

• Journal Article Type: Article
• Acceptance Date: Jan 10, 2020
• Online Publication Date: Feb 26, 2020
• Publication Date: Feb 26, 2020
• Deposit Date: Jan 22, 2020
• Publicly Available Date: Feb 26, 2020
• Journal: BMJ
• Print ISSN: 0959-8138
• Electronic ISSN: 1756-1833
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 368
• Issue: 368
• Article Number: m322
• DOI: https://doi.org/10.1136/bmj.m322
• Public URL: https://nottingham-repository.worktribe.com/output/3782490
• Publisher URL: https://www.bmj.com/content/368/bmj.m322