Costs included drugs, physician visits, lab tests, adverse events, HCV disease complications and multidisciplinary ECHO personnel (physician, pharmacist, psychiatrist, nurse manager, coordinator, user support analyst). We also performed an analysis of
the cost of antiviral treatment if patients instead traveled to the academic center to receive care compared with ECHO personnel costs. Travel costs included mileage, selleck kinase inhibitor patient time and for prisoners guard costs. We used quality of life adjustments to account for antiviral treatment and diseaserelated morbidity. Costs and effectiveness were discounted at 3% yearly. Results: ECHO access to HCV treatment increased discounted quality-adjusted life expectancy by 3. 8 (SD 1. 4) years overall, 3. 5 (SD 1. 3) years in the community and 4. 2 (SD 1. 4) years in the prison dwellers. ECHO dominated no antiviral therapy by resulting in lower lifetime costs and higher quality-adjusted life expectancies for 62% of the 261 patients and 55% of the community and 70% of the prison dwellers. Among the non-dominated patients, the incremental cost-effectiveness ratio of ECH〇 averaged $8300 (SD $7800) per
qualityadjusted life year (QALY) gained overall, $9400 (SD $8500) in the community and $5900 (SD $5300) in prison dwellers, well below the standard US willingness to pay threshold selleck compound of $50, 000 per QALY gained, making ECHO “cost-effective”. When comparing only antiviral treatment costs and travel and lost work time costs to ECHO costs (no disease costs), the mean savings from ECHO were $1352 per person or >$350, 000 for the 261 patients. For 10% of patients, travel costs were lower than ECHO costs because of their geographic proximity to the academic center. Conclusion: ECHO-facilitated HCV treatment is not only effective but also cost-effective, suggesting that ECHO
provides resource efficient care access for underserved communities. Confirmation of these results in additional studies and in other diseases is needed and warranted. Disclosures: The following people have nothing to Inositol monophosphatase 1 disclose: John B. Wong, Karla A. Thornton, Christie Carroll, Sanjeev Arora Objective: Document the impact of viral load suppression and treatment of risk of morbidity and mortality in patients with hepatitis C virus [HCV] infection receiving care through the U. S. Veterans Health Administration [VHA]. Methods: Study patients were selected from the VHA’s HCV Clinical Case Registry [CCR] covering the period 1999-2012 if they had a detectable viral load [>25 IU/ml] and a recorded viral genotype.