Author: Gutkind S, Starbird L, Murphy SM, Feaster D, Metsch L, Schackman BR

Theme: Social Science & Policy Research Year: 2019

Background: We evaluated the economic cost of care facilitation for linkage to hepatitis C virus (HCV)
care among HIV/HCV co-infected individuals with substance use disorder enrolled in HIV care, using data
from a 6-month multi-site randomized trial.
Methods: Participants were enrolled from 8 HIV clinics across the US and randomized to receive care
facilitation for linkage to HCV care (n=51) or treatment as usual (TAU, n=62). Data were collected
prospectively alongside the trial and during site visits to identify additional resources used to deliver
care facilitation intervention. We used micro-costing methods to evaluate costs incurred from the
healthcare sector and patient perspectives in 2017$, applying national labor rates. We calculated
median clinic start-up costs and mean incremental cost per care facilitation participant (excluding
overhead costs).
Results: The median site start-up cost was $6,979 (range: $4,634-$7,778), primarily consisting of onsite
and webinar trainings for care facilitators and site staff. The median site weekly cost for supervision and
client outreach was $1,156 (range: $511-$3,222).The mean cost per care facilitator visit was $54, with a
mean of 10.25 visits per participant. This cost includes visits delivered in-person or by telephone and
staff travel to and from in-person visits. The mean cost per care facilitator contact with non-participants
(e.g. other providers) was $20, with a mean of 11.35 of these contacts per participant. The mean total
cost per participant to deliver the 6-month care facilitation intervention was $3,854. Mean participant
time and travel costs were $6 per in-person visit, and $81 over the intervention. Participants in the
intervention arm reported fewer hospitalizations outside of the intervention than participants receiving
Conclusion: Care facilitation for linkage to HCV care cost approximately $3,854 per participant. Face-toface visits represented the majority of the intervention costs. Potential cost offsets resulting from fewer
hospitalizations need to be investigated.
Disclosure of Interest: All authors received funding from National Institute on Drug Abuse (NIDA) for
this study.

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