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.