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Early Screenings Boost Hepatitis C Chronic Disease Management

Early screenings and quicker treatments may significantly aid the process of chronic disease management for hepatitis C patients, a new study finds.

By Jacqueline Belliveau

- Healthcare providers may be wasting their resources on healthcare initiatives focused on screening at-risk populations for specific diseases if comprehensive chronic disease management programs are not in place for the same conditions, reported a new study in The American Journal of Managed Care.

Chronic disease management processes for hepatitis C patients to benefit from earlier screenings and treatment

Researchers revealed that there would be an $824 billion increase in social value if more individuals were screened for hepatitis C virus (HCV) infection, and if those infected patients received fibrosis treatment in the beginning stages of the condition.

When diagnosed patients received treatment in the last two stages of the disease, the net social value decreased to $0.68 billion despite expanding screening policies.

“Increasing screening for HCV [hepatitis C virus] infection may generate considerable value for society, but only when paired with access to treatment at earlier stages of the disease,” stated the study. “This result highlights the importance of implementing policies to ensure patients who receive an HCV-positive diagnosis remain in the healthcare system until they receive treatment and achieve SVR [sustained virologic response].”

Even though an estimated 3.5 million individuals are living with chronic HCV infection in the US, about 50 to 75 percent of infected individuals are still not screened for the condition until serious symptoms develop in the later stages of the disease.

To encourage healthcare providers to intervene in earlier stages, the CDC and American Association for the Study of Liver Diseases have both recently updated their guidelines on HCV infection screening. The organizations urge healthcare providers to screen baby boomers, which make up around 75 percent of the HCV-positive population.

However, researchers noted that more than 40 percent of physicians do not know of the current screening guidelines.

The majority of infected patients are also not receiving appropriate treatments for the condition, the study pointed out. Out of the patients diagnosed with chronic HCV infection, only 13 to 36 percent have received treatment and even fewer HCV-positive individuals have completed the treatment regime.

Using various scenarios, the study aimed to determine the how much expanding screening and treatment for HCV infection would benefit the healthcare industry. The report detailed different scenarios that either added screening guidelines to include one-time testing of all individuals born before 1992, improved physician education of guidelines, or both.

Researchers discovered that increasing screening for HCV infection would create a positive social value in 20 years, but the value decreases without subsequent advances in HCV management.

When HCV-positive patients received fibrosis care in the first three stages of the disease, healthcare investments in screening and treatment would break even after eight to nine years. For HCV-positive patients who received treatment in the last two stages of the disease, investments would break even after 20 to 22 years.

Additionally, researchers found that adding screening guidelines contributed the most social value in all of the tested scenarios. Expanding policies incurred large short term costs, but it produced a positive social value in only five to seven years.

Like the other scenarios, the benefits of increasing screen guidelines were restricted based on availability of fibrosis care. However, when patients were treated in the early stages of HCV infection, the savings from reduced medical costs outweighed the overall costs of treatments.

While advanced screening and treatment may pay off in as little as eight years, the researchers reported that most of the scenarios generated high up-front healthcare costs. Healthcare providers might view short-term costs as a barrier to implementing improved chronic disease management programs.

The study also explained that social value benefits may be limited because many HCV-positive patients do not adhere to fibrosis treatment plans.

“Because of patient turnover, private payers and state Medicaid systems may not retain patients long enough to directly benefit from their investments in HCV treatment,” wrote the authors of the study. “Furthermore, whereas the costs of screening and treatment are borne by insurers and other payers, only a small portion of the benefits accrue directly to them (in the form of reduced future medical costs).”

With the onset of value-based care, more providers are turning to chronic disease management programs to cut costs and improve quality care. However, healthcare organizations may need to reevaluate their strategies to ensure that patients are receiving the right treatments at the right times.

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