A modelling analysis of financial incentives for hepatitis C testing and treatment uptake delivered through a community‐based testing campaign

Abstract

Financial incentives may reduce opportunity costs associated with people who become lost to follow‐up in hepatitis C treatment programs. We estimated the impact that different financial incentive amounts would need to have on retention in care to maintain the same unit cost per (1) RNA‐positive person completing testing (defined as awareness of RNA status) and (2) RNA diagnosed person initiating treatment. Costing data were obtained from a 2019 community‐based testing campaign focused on engaging people who inject drugs. For different financial incentive amounts, we modelled the corresponding improvements in retention in care that would be needed to maintain the same overall (1) unit cost per testing completion and (2) unit cost per treatment initiation. In the testing campaign, the unit cost per RNA‐positive person completing testing was A$3215 and the unit cost per RNA diagnosed person initiating treatment was A$1055. Modelling found that an incentive of A$500 per RNA‐positive person completing testing would result in more people completing testing for the same unit cost if the percentage of attendees receiving their test results increased from 63% to 74%. An incentive of A$200 per RNA diagnosed person initiating treatment would result in more people initiating treatment for the same unit cost if the percentage initiating treatment increased from 67% to 83%. Monetary incentives for completing testing and initiating treatment may be an effective way to increase retention in care without increasing the overall unit cost of completing testing/initiating treatment.

A multi‐site, nurse‐coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia

“…Similarly, although more research is required, incentives may also be of utility in improving engagement in HCV treatment. 24,25 The proportion of people commencing treatment (74%) was similar to a study from four sites that are part of the Queensland Injectors Network where 72% of people commenced treatment. 26 Like our findings, amongst people who had an SVR test, 97% were cured.…”

“…Removal of this barrier through the simplification of testing, including point of care rapid testing 23 combined with the implementation of same‐day treatment commencement may be of benefit in addressing this. Similarly, although more research is required, incentives may also be of utility in improving engagement in HCV treatment 24,25 …”

Evaluation of a Project Integrating Financial Incentives into a Hepatitis C Testing and Treatment Model of Care at a Sexual Health Service in Cairns, Australia, 2020–2021

“…Among the clients diagnosed with hepatitis C during the intervention, almost all received a prescription for DAA therapy, and three in four completed DAA treatment. In the context of mathematical modelling from Australia demonstrating that financial incentives result in modest increases in treatment initiation among people diagnosed with chronic hepatitis C and remain cost-effective up to AUD 200, the financial incentives model evaluated in this study was also likely highly costeffective [28].…”

Eliminating hepatitis C in Australia: a novel model of hepatitis C testing and treatment for people who inject drugs at a medically supervised injecting facility

“…The recent Therapeutic Goods Administration approval of point‐of‐care HCV RNA fingerstick tests provides an exciting opportunity to further remove barriers to hepatitis C care, and models incorporating point‐of‐care HCV RNA testing have been highly acceptable in other settings 18,19 . Further strategies to increase engagement, including financial incentives and “blitz” days supported by increased resources and a focus on hepatitis C care, should also be considered 20,21 . Given the relatively high rates in our study of homelessness, psychiatric illness, and heavy alcohol use among people who were tested for hepatitis C, they may be more likely to use the supervised injecting facility as their primary health care service.…”