Efficiency of the Relink C strategy: identification and retrieval of chronic HCV patients full and partial diagnosed but unlinked to care
Main Article Content
Abstract
Background: The existence of patients with Hepatitis C virus who were diagnosed but unlinked to care (DBUC) hinders the Hepatitis C elimination. The objectives were to present the results of the ReLink-C strategy in three Spanish hospitals and analyse its efficiency for both patients with positive viral load testing (full diagnosis) and with HCV antibodies, but without positive viral load testing (partial diagnosis); and partial diagnosis only.
Methods: The strategy was divided in two phases: Phase I, DBUC patients with complete or partial diagnosis without follow-up from Microbiology unit were searched and identified; and Phase II, missing patients were contacted by telephone and referred to Hepatology for further treatment. In addition, the characteristics (age, gender, country of origin and fibrosis status) of the lost and treated patients were collected.
Results: The three hospitals identified 3,444 patients to search for retrieval, 1,538 (45%) with full diagnosis and 1,906 (55%) partial diagnosis. Overall, about 35% (1,221/3,444) were DBUC and the ReLink-C strategy successfully localised 903 patients, of which 493 patients were linkage to care and 273 were treated. The ReLink-C strategy (full and partial diagnosis) compared to no intervention showed a reduction in liver and mortality complications (range 22-29%) with an incremental cost-utility ratio of €8,958/patient, and in case of partial diagnosis of €9,396/patient.
Conclusions: The Relink-C active search strategy enabled the retrieval and treatment of a significant number of diagnosed hepatitis C cases that would not have been detected in clinical practice. It was cost-effective for both (full and partial diagnosis) and partial diagnosis only, being in line with the 2030 hepatitis C elimination targets.
Keywords:
diagnosed but unlinked to care, cost-effectiveness, HCV infection
Article Details
How to Cite
HERNÁNDEZ, Raquel Domínguez et al.
Efficiency of the Relink C strategy: identification and retrieval of chronic HCV patients full and partial diagnosed but unlinked to care.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6149>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.6149.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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32. Gómez De La Cuesta S, Martín-Arribas MI, Mateos Hernández MI, Oliva Oliva A, Geijo Martínez F. Hepatitis C virus micro-elimination in vulnerable populations before and during a global pandemic. Rev Esp Enferm Dig. Published online 2022. doi:10.17235/reed.2022.9275/2022
33. Ortega González E, Ocete Mochón MD, Gimeno Cardona C, et al. Opportunistic population screening as a hepatitis elimination strategy: the CRIVALVIR-FOCUS program. International Journal of Infectious Diseases. 2024;146:107131. doi:10.1016/j.ijid.2024.107131
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4. Ministerio de Sanidad. Plan estratégico para el abordaje de la Hepatitis C en el SNS (PEAHC). October 2020. Accessed November 3, 2023. https://www.sanidad.gob.es/ciudadanos/enfLesiones/enfTransmisibles/hepatitisC/PlanEstrategicoHEPATITISC/docs/Plan_Estrategico_Abordaje_Hepatitis_C_(PEAHC).pdf
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6. García F, Domínguez-Hernández R, Casado M, et al. The simplification of the diagnosis process of chronic hepatitis C is cost-effective strategy. Enferm Infecc Microbiol Clin (Engl Ed). 2019;37(10):634-641. doi:10.1016/j.eimc.2019.03.001
7. Torrecillas M, Gómez-Muñoz N, Ocete MD, et al. One-step diagnosis strategy together with multidisciplinary telematics referral perform an effective approach for identifying and treating patients with active Hepatitis C infection. Ann Hepatol. 2022;27(1):100542. doi:10.1016/j.aohep.2021.100542
8. Andaluz García I, Arcos Rueda MDM, Montero Vega MD, et al. Patients with hepatitis C lost to follow-up: ethical-legal aspects and search results. Rev Esp Enferm Dig. 2020;112(7):532-537. doi:10.17235/reed.2020.7077/2020
9. Morales-Arraez D, Hernández-Bustabad A, Reygosa Castro C, et al. Reengagement strategies for hepatitis C patients lost to follow-up: A randomized clinical trial. Hepatol Commun. 2023;7(6):e0080. doi:10.1097/HC9.0000000000000080
10. Guerra Veloz MF, Del Pino Bellido P, Cordero Ruiz P, et al. HCV microelimination strategies: An interventional study in diagnosed patients without access to the system. Liver Int. 2021;41(5):928-933. doi:10.1111/liv.14824
11. Del Pino Bellido P, Guerra Veloz MF, Cordero Ruiz P, et al. Chronic hepatitis C patients lost in the system: predictive factors of non-referral or loss of follow-up in Hepatology units. Rev Esp Enferm Dig. 2021;113(12):833-839. doi:10.17235/reed.2020.7573/2020
12. Aleman S, Söderholm J, Büsch K, Kövamees J, Duberg AS. Frequent loss to follow-up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus. Liver Int. 2020;40(8):1832-1840. doi:10.1111/liv.14469
13. Burgui C, Martín C, Juanbeltz R, et al. Recapture of patients with an incomplete diagnosis of hepatitis C virus infection. Rev Esp Enferm Dig. 2020;112. doi:10.17235/reed.2020.6944/2020
14. Vargas-Accarino E, Martínez-Campreciós J, Domínguez-Hernández R, et al. Cost-effectiveness analysis of an active search to retrieve HCV patients lost to follow-up (RELINK-C strategy) and the impact of COVID-19. J Viral Hepat. 2022;29(7):579-583. doi:10.1111/jvh.13686
15. Ministry of Health. Prevalence of hepatitis C in Spain: results from a national population based survey in 2017-2018. July 27, 2020. Accessed April 23, 2024. http://www.mscbs.es/ciudadanos/enfLesiones/enfTransmisibles/sida/hepatitis/Prevalence.pdf
16. Chang SS, Hu HY, Chen YC, Yen YF, Huang N. Late hepatitis C virus diagnosis among patients with newly diagnosed hepatocellular carcinoma: a case-control study. BMC Gastroenterol. 2022;22(1):425. doi:10.1186/s12876-022-02504-6
17. López-Bastida J, Oliva J, Antoñanzas F, et al. Spanish recommendations on economic evaluation of health technologies. Eur J Health Econ. 2010;11(5):513-520. doi:10.1007/s10198-010-0244-4
18. Turnes J, Domínguez-Hernández R, Casado MÁ. Cost-effectiveness analysis of two treatment strategies for chronic hepatitis C before and after access to direct-acting antivirals in Spain. Gastroenterol Hepatol. 2017;40(7):433-446. doi:10.1016/j.gastrohep.2017.05.004
19. Esteban R, Domínguez-Hernández R, Cantero H, Casado MÁ. Evaluation of the clinical and economic value of sofosbuvir/velpatasvir (SOF/VEL) in patients with chronic hepatitis C in Spain during the last 5 years. Gastroenterología y Hepatología. Published online May 2024:S0210570524001572. doi:10.1016/j.gastrohep.2024.502199
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21. Retribuciones Canarias. Retribuciones-Personal-estatutarios_Canarias 2023-2022. Accessed March 13, 2024. https://www3.gobiernodecanarias.org/sanidad/scs/content/6d5a6473-9362-11ea-979a-3b49391d2a8b/Retribuciones-estatutarios.pdf
22. Retribuciones Comunidad Valenciana. Tablas retributivas del personal al servicio de las instituciones sanitarias de la Conselleria competente en materia de sanidad. 2023. Accessed March 13, 2024. https://www.san.gva.es/es/web/recursos-humans/retribuciones-personal-iiss
23. eSalud Database. Costs and prices of the health sector. Barcelona. Accessed January 31, 2023. http://esalud.oblikue.com/
24. García-Herola A, Domínguez-Hernández R, Casado MÁ. Clinical and economic impact of an alert system in primary care for the detection of patients with chronic hepatitis C. PLoS One. 2021;16(12):e0260608. doi:10.1371/journal.pone.0260608
25. Morales-Arraez D, Nieto Bujalance Y, Diaz-Flores F, et al. Risk of liver fibrosis progression in patients with suboptimal diagnosis of hepatitis C virus infection. Eur J Gastroenterol Hepatol. 2020;32(4):528-534. doi:10.1097/MEG.0000000000001534
26. Morales-Arraez D, Alonso-Larruga A, Diaz-Flores F, et al. Predictive factors for not undergoing RNA testing in patients found to have hepatitis C serology and impact of an automatic alert. J Viral Hepat. 2019;26(9):1117-1123. doi:10.1111/jvh.13122
27. Isfordink CJ, van Dijk M, Brakenhoff SM, et al. Hepatitis C Elimination in the Netherlands (CELINE): How nationwide retrieval of lost to follow-up hepatitis C patients contributes to micro-elimination. Eur J Intern Med. 2022;101:93-97. doi:10.1016/j.ejim.2022.04.024
28. Isfordink CJ, Brakenhoff SM, van Dijk M, et al. Hepatitis C elimination in the Netherlands (CELINE): study protocol for nationwide retrieval of lost to follow-up patients with chronic hepatitis C. BMJ Open Gastroenterol. 2020;7(1):e000396. doi:10.1136/bmjgast-2020-000396
29. Beekmans N, Klemt-Kropp M. Re-evaluation of chronic hepatitis B and hepatitis C patients lost to follow-up: results of the Northern Holland hepatitis retrieval project. Hepatol Med Policy. 2018;3:5. doi:10.1186/s41124-018-0032-9
30. Ministerio de Sanidad. Guía de cribado de la infección por el virus de la hepatitis C; 2020. Accessed April 8, 2024. https://mirror.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/hepatitis/ciudadanosMenu.htm
31. Llaneras J, Ruiz-Cobo JC, Rando-Segura A, et al. Integrating viral hepatitis management into the emergency department: A further step towards viral hepatitis elimination. JHEP Reports. 2024;6(1):100932. doi:10.1016/j.jhepr.2023.100932
32. Gómez De La Cuesta S, Martín-Arribas MI, Mateos Hernández MI, Oliva Oliva A, Geijo Martínez F. Hepatitis C virus micro-elimination in vulnerable populations before and during a global pandemic. Rev Esp Enferm Dig. Published online 2022. doi:10.17235/reed.2022.9275/2022
33. Ortega González E, Ocete Mochón MD, Gimeno Cardona C, et al. Opportunistic population screening as a hepatitis elimination strategy: the CRIVALVIR-FOCUS program. International Journal of Infectious Diseases. 2024;146:107131. doi:10.1016/j.ijid.2024.107131