Project ECHO model appears cost-effective for HCV diagnosis, treatment

The incremental cost-effectiveness ratio with Project ECHO versus usual care was $10,351 per QALY, with 95.6% of iterations falling below a willingness-to-pay threshold of $50,000 per QALY and more than 99.9% falling below a willingness-to-pay threshold of $100,000 per QALY.


Diagnosis and treatment of hepatitis C virus (HCV) through Project ECHO, a primary care-focused model, appear to be cost-effective, a recent study found.

Researchers performed a cost-effectiveness analysis of diagnosis and treatment of HCV in a hypothetical panel of primary care patients with and without Project ECHO (Extension for Community Healthcare Outcomes). The Project ECHO model supports primary care clinicians in caring for complex conditions in underserved populations by linking them to a multidisciplinary team of subspecialists via weekly video conferences that offer teaching and mentoring. Patients in the Project ECHO group were assumed to receive HCV diagnosis and treatment from their primary care clinicians, while those in the comparison group were considered to be referred to subspecialists for treatment after diagnosis.

Markov models were used to simulate disease progression, quality of life, and life expectancy in patients with HCV and those in the general population. Data from the University of New Mexico's Project ECHO for HCV were used to determine treatment rates, and increases in survival, quality-adjusted life-years (QALYs), costs, and budget impact were compared in patients who were cared for via Project ECHO and those who were not. The study results were published Oct. 23 by Gastroenterology.

The number of QALYs for patients with HCV was 15.04 in those cared for by Project ECHO versus 13.63 QALYs in those receiving usual care. The annual rate of screening and diagnosis was 58% in the Project ECHO group and 17.9% in the usual care group. The incremental cost-effectiveness ratio with Project ECHO versus usual care was $10,351 per QALY, with 95.6% of iterations falling below a willingness-to-pay threshold of $50,000 per QALY and more than 99.9% falling below a willingness-to-pay threshold of $100,000 per QALY. The researchers could not confirm why treatment rates were better with Project ECHO but noted that results were mainly independent of cause in sensitivity analyses. In a budget impact analysis, the authors found that payers would need to invest another $339.54 million over five years to increase treatment by 4,446 patients per 1 million covered lives.

The authors noted that their study is limited because they couldn't determine why Project ECHO patients had better treatment rates, they may have overestimated rates and numbers of severe disease stages, and the true prevalence of HCV in primary care patient panels isn't known. However, they concluded that while treatment costs per patient in a model like Project ECHO may initially increase, the model can be cost-effective in providing specialized care to patients in underserved areas. Although their results are not generalizable to other care models or other conditions, they wrote, “The demonstrable improvements to the health care system attributable to applying Project ECHO's model to HCV treatment across the United States give credence to performing cost-effectiveness analyses of Project ECHO in other disease states.”