A Modelling Analysis of Financial Incentives for Hepatitis C Testing and Treatment Uptake Delivered Through a Community-based Testing Campaign

Anna Y. Palmer; Kico Chan; Judy Gold; Chloe Layton; Imogen Elsum; Margaret Hellard; Mark Stoove; Joseph S. Doyle; Alisa Pedrana; Nick Scott

Disclosures

J Viral Hepat. 2021;28(11):1624-1634. 

In This Article

Results

EC Testing Campaign Cost Calculation

The total cost of the EC Testing Campaign, including pre-event costs, event costs, testing-specific costs and treatment costs, was estimated to be A$58,780 (Table 1). Over half of these costs were associated with event planning and running costs (A$33,335, 57%), while A$14,895 (25%) was associated with testing-specific costs and A$10,550 (18%) was associated with treatment. Approximately A$2000 (3% of the total costs) was spent on incentives during the campaign to encourage take up of testing. The average unit cost per RNA-positive person completing testing was A$3215. The average unit cost per RNA diagnosed person initiating treatment was A$1055.

In baseline unit cost sensitivity analyses, varying the costs by 10% did not have a substantial impact on the unit cost per RNA-positive person completing testing and RNA diagnosed person initiating treatment (Table 2). However, varying the percentage of people retained in care and the RNA positivity rate did substantially impact the unit costs. For example, when the RNA positivity rate was 10% (as opposed to 35% in the EC Testing Campaign), the cost per RNA-positive person completing testing increased from A$3215 to A$11,110 and the cost per RNA diagnosed person initiating treatment increased from A$1055 to A$2373.

Incentives Modelling

When incentives for testing completion were modelled, the proportion of RNA-positive attendees completing testing needed to increase to retain the same unit baseline cost (i.e., the unit cost per RNA-positive person completing testing through the EC Testing Campaign) (Figure 3a). For example, in the baseline case, 63% (15/24) of RNA-positive attendees returned for their test results. However, modelling showed that if an incentive of A$500 was given to each RNA-positive person returning for their results, the program would retain the same unit cost if it delivered an 11 percentage point increase in the number of RNA-positive people completing testing, from 63% to 74%. The program could no longer retain the same unit cost for any increase in retention in care after testing if incentive values were above A$1200 per RNA-positive person completing testing.

Figure 3.

Graph showing (a) the percentage of RNA-positive people that need to complete testing and (b) the percentage of RNA diagnosed people that need to initiate treatment to maintain the same unit cost. Dotted lines show the percentage of RNA-positive people that need to complete testing for an incentive of A$500 and the percentage of RNA diagnosed people that need to initiate treatment for an incentive of A$200

When incentives for treatment initiation were modelled, the proportion of RNA diagnosed attendees initiating treatment needed to increase to retain the same unit baseline cost (i.e., the unit cost per RNA diagnosed person initiating treatment through the EC Testing Campaign) (Figure 3b). For example, in the baseline case (where no incentives were given for treatment initiation), 67% (10/15) of RNA diagnosed individuals initiated treatment. However, modelling showed that if an incentive of A$200 was given to each RNA diagnosed person upon treatment initiation, the program would retain the same unit cost if it delivered a 16 percentage point increase in the number of RNA diagnosed people initiating treatment, from 67% to 83%. The program could no longer retain the same unit cost for any increase in retention in care at treatment if incentive values were above A$340 per RNA-positive person completing testing.

In the incentives model sensitivity analyses, varying the costs by 10% did not have a substantial impact on the incentive amount and the percentage of people that need to be retained in care (Figure 4.a.ii. & 4.b.ii.). However, varying the percentage of attendees who completed testing/initiated treatment at baseline and the RNA positivity rate did have a substantial impact on the incentive thresholds calculated. For example, in the scenario where 80% of attendees completed testing at baseline (Figure 4.a.i.), an incentive of A$500 would need to increase retention in care by 20 percentage points (from 80% to 100%) to retain the same unit cost. However, in the scenario where 40% of attendees completed testing at baseline, an incentive of A$500 would only need to increase retention in care by 4 percentage points (from 40% to 44%) to retain the same unit cost. Further, in the scenario where RNA positivity was 50% (Figure 4.a.iii.), an incentive of A$500 would need to increase retention in care by 17 percentage points (from 63% to 80%) to retain the same unit cost. However, in the scenario where RNA positivity was 10%, an incentive of A$500 would only need to increase retention in care by 2 percentage points (from 63% to 65%) to retain the same unit cost. The results were similar when incentives for treatment initiation were modelled.

Figure 4.

Figure showing the incentives model sensitivity results. The left column (b) shows results for incentives applied to the cost per RNA + person completing testing and the right column shows results for incentives applied to the cost per RNA diagnosed person initiating treatment. Sensitivity is performed on the percentage of people completing testing/initiating treatment at baseline (4.a.i. & 4.b.i.), overall costs of testing/treatment (4.a.ii. & 4.b.ii.) and the RNA positivity rate (4.a.iii. & 4.b.iii)

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