Multidisciplinary managed care networks-Life-saving interventions for hepatitis C patients

Background: Successful hepatitis C virus (HCV) therapy depends on effective pathways of care. Over 2 decades we have developed 4 sequential models of care latterly using a multi-disciplinary managed care network (MCN) to improve HCV testing, care and treatment.

Methods: Cohort study to evaluate the effectiveness of care pathways, carried out using all HCV antibody positive individuals tested in a geographical region between 1994 and 2014.

Results: Study of 3122 HCV positive patients. They were divided into four subgroups representing different care pathways defined by their date of HCV antibody diagnosis. The number who accessed treatment services within 1 year of diagnosis increased from 77/292 (26.3%) to 521/821 (72.9%). The rate of treatment starts within 1 year of diagnosis increased from 6/292 (2.0%) to 133/821 (16.2%), and the sustained viral response rate improved from 61.6% to 77.4%. All-cause mortality decreased from 232/688 (33.7%) in subgroup A to 55/1207 (4.5%) in subgroup D, multivariate analysis showed that pathway type was an independent predictor of mortality irrespective of age, sex, SVR status or HIV co-infection with pathway D having an odds ratio of 0.53(0.40-0.77 p<0.001) compared to pathway in A. At study end 78% (3122) of estimated 4000 HCV positive had been diagnosed. 97.5% of HCV caseload was referred to Specialist Services and 89% attended for assessment.

Conclusions: The introduction of a MCN increases access to care and reduced all cause mortality.