HCV telemedicine program satisfying, cost-effective in Spanish prison

SAN FRANCISCO — A telemedicine program brought high levels of satisfaction and proved cost effective in patients with hepatitis C in a Spanish prison, according to data presented at The Liver Meeting 2018.

Susana Llerena , MD, of the Hepatology Unit at Marques De Valdecilla University Hospital in Spain, and colleagues aimed to assess whether a telemedicine program could be useful in eliminating HCV in the El Dueso Penitentiary Center in Cantabria, Spain.

“In prisons, there is a high concentration of comorbidities,” Llerena said. “This is a population at risk for the spread of new infections. The use of telemedicine allows us to improve access to specialized care for isolated populations, such as inmates.”

Llerena suggested that this is the first study to look at telemedicine in a prison population. “Our aim was to evaluate the effectiveness of telemedicine from two points of view: we carried out a satisfaction assessment, and a cost-effectiveness assessment,” she said. The full cohort included 847 patients, of whom 69 had HCV.

The intervention included a universal test-and-treat strategy conducted between 2016 and 2017. The study had multiple phases, from defining the work team, to acquiring informed consent, to setting up the telemedicine program. Ultimately, in the key phase, universal treatment of inmates was initiated.

The satisfaction survey included 11 questions pertaining to seeing and communicating with the doctor, according to Llerena. “A score of four points indicates a high level of satisfaction,” she said.

The cost-effectiveness analysis was conducted using a decision tree that accounted for medical and non-medical costs, along with direct and indirect costs, and treatment costs.

The data set included 64 patients with HCV were available in the ITT analysis. “Only four inmates refused to participate, so our screening rate was over 99%,” Llerena said.

Results showed an SVR rate of 92.4% in the ITT analysis and 95% in the per-protocol analysis, according to Llerena

Regarding the satisfaction survey, scores hovered around four, according to Llerena. “There was a high degree of satisfaction,” she said.

Cost analysis findings showed that regular medical care required 1,774 euros per patient, whereas telemedicine required 1,159 euros per patient. “Therefore, the telemedicine program produced an average savings of 579 euros per patient,” Llerena said.

She added that the savings were seen in both direct and indirect medical expenses.

“We can say that the use of a telemedicine program is an extraordinarily useful tool in the monitoring and treatment of HCV in prisoners,” Llerena said. “We believe that a telemedicine program is the most efficient strategy due to the savings in cost derived from hospital transfers and other indirect costs.”

Llerena also highlighted the high satisfaction rate among the population. “Despite the complexity of inmate populations, including comorbidities and drug abuse, the telemedicine program is a satisfactory tool for the patients.” – by Rob Volansky

Reference:

Llerena S, et al. Abstract #0053. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.

Disclosure: Llerena reports no relevant financial disclosures.