Hepatitis C Virus (HCV) Cost Calculator
The HCV Cost Calculator is based off of an evidenced based model piloted at the Public Health Management Corporation Care Clinic in Philadelphia, PA. Throughout the calculator, “Standard Screening” references current risk based CDC screening guidelines including persons born 1945-1965, persons who previously or currently inject drugs, and other associated risk factors. “Universal Screening” references screening patients 18 years and older, regardless of risk factors. “Enhanced” services are those identified as promising practices in the model, including: Medical Assistant (MA) initiated opt-out universal screening, reflex testing, care coordination for prior authorizations, integrated behavioral health consultation, and onsite treatment.
NNCC’s HCV Cost Calculator is an interactive tool designed to evaluate the costs and benefits of Standard vs Enhanced HCV Care. The HCV Cost Calculator uses a numerical value-based model of health center staff training, screening, and treatment regimen to estimate the cost-benefit comparison and return on investment (ROI) to the health center.
What is the HCV prevalance in your health center?
How many patients does your health clinic screen?
Standard screening includes patients in the birth cohort - and other risk factors. Unviersal screening includes all patients aged 18 or older.
Standard Screening:
Risk-based, birth cohort - and associated risk factors:
Universal Screening:
Eligible patients 18 and older, if have not had test done already
What kind of insurance do your patients have?
Medicaid
Medicare/Private
Uninsured
Total: 100
What services does your health center provide on-site?
Screening Type:
Standard screening includes patients in the birth cohort - and based on other risk factors.
Universal screening includes all patients aged 18 or older who have not yet been tested.
Standard Screening
Universal Screening
HCV Test:
Rapid Test: Fingerstick that takes 20 minutes for an Ab result but still requires a blood draw to confirm RNA positive diagnosis
Reflex HCV to RNA Test: One blood draw that if Ab positive, automatically reflex tests to confirm RNA positive diagnosis.
Rapid Test
Reflex HCV to RNA Test
Treatment location:
Referral to Specialist: Health center does not provide HCV treatment onsite, but protocol is to refer to outside specialist, hepatology or infectious disease.
On-site HCV Treatment: Health center protocol to treat HCV positive patients with in-house primary care or in-house specialty care.
Referral to Specialist
On-site HCV Treatment
Additional Services:
Behavioral Health Services: counseling with Behavioral Health Specialist about medication adherence and substance use disorder and/or mental health diagnoses
Link to Primary Care: appointment to inform patient about hepatitis diagnosis, medication adherence, potential side effects and next steps to start treatment.
Behavioral Health Services
Link to Primary Care
What services would you like to add to your current HCV programming?
Care Coordination: wrap around services for the patient to support throughout care continuum, specifically follow up to schedule appointments and helping with prior authorization processes, if required.
Substance Use Disorder Counseling: counseling appointment with patient to discuss co-occurring substance use disorder and impact on treatment.
See above for additional definitions.
Universal Screening
Reflex HCV to RNA
On-site HCV Treatment
Behavioral Health Services
Substance Use Disorder Counseling
Care Coordination
What are your state Medicaid HCV treatment restrictions?
Fibrosis Severity (F-score) Restriction
Medicaid HCV Sobriety Restriction
Medicaid HCV Prescriber Restriction % Treated
Revenue includes reimbursement rates for 340B.
If the health center does not have a 340B agreement, please contact NNCC for a more detailed version of the calculator.
Inputs:
| HCV Prevalence: | 1% |
| Patients birth cohort 1950-1970: | 250 |
| Patients total: | 800 |
| Insurance, % Medicaid: | 50% |
| Insurance, % Medicare/Private: | 30% |
| Insurance, % Uninsured: | 20% |
| Screening Type: | Standard |
| HCV Test: | Rapid |
| Treatment Location: | Referral to Specialist |
| Additional Services: | |
| Fibrosis Restrictions | No F-Score Restriction/Mild F-Score Required (F0-F1) |
| Medicaid Sobriety Restrictions: | No sobriety restriction or counseling/screening only |
| Medicaid Provider Restrictions: | No provider restriction |
Results
250
Patients Screened
1
Identified Positive
550
Increase in Universal Screening
6
Increase in Universal Identified
Screening Costs and Revenue
Based on 2017 costs and reimbursement rates
Universal Screening Cost-Benefit Ratio
Benefit-Cost Ratio: Difference in savings divided by difference in costs (Benefit-cost ratio > 1 indicates that the intervention being studied saves money (relative to the comparison intervention); Benefit-cost ratio < 1 indicates that the intervention costs more than it saves)
1.12
Universal Screening ROI
Return on Investment (ROI): (Savings-Costs)/Costs, measured in percentage
11.84%
Treatment Costs and Revenue
Enhanced Treatment Cost-Benefit Ratio
Benefit-Cost Ratio: Difference in savings divided by difference in costs (Benefit-cost ratio > 1 indicates that the intervention being studied saves money (relative to the comparison intervention); Benefit-cost ratio < 1 indicates that the intervention costs more than it saves)
1.04
Enhanced Treatment ROI
Return on Investment (ROI): (Savings-Costs)/Costs, measured in percentage
3.68%
Overall Margins
Universal Screening and Enhanced Treatment Cost-Benefit Ratio
Benefit-Cost Ratio: Difference in savings divided by difference in costs (Benefit-cost ratio > 1 indicates that the intervention being studied saves money (relative to the comparison intervention); Benefit-cost ratio < 1 indicates that the intervention costs more than it saves)
1.04
Universal Screening and Enhanced Treatment ROI
Return on Investment (ROI): (Savings-Costs)/Costs, measured in percentage