Cost-effectiveness analysis of an active search to retrieve HCV patients lost to follow-up (RELINK-C strategy) and the impact of COVID-19

In order to achieve hepatitis C virus (HCV) elimination, strategies are needed to identify HCV patients and link them to care. This study aimed to evaluate the value of retrieval of HCV-RNA positive lost to follow-up (LTFU) individuals for treatment (ReLink-C strategy) and the impact of the COVID-19 pandemic. ReLink-C involved a retrospective search in microbiology databases of the Barcelona North Health Area (450,000 inhabitants) to identify and retrieve HCV-RNA positive individuals LTFU. The search encompassed two periods (pre-COVID-19 and COVID-19) and the impact of the pandemic on this strategy was assessed. A Markov model estimated lifetime cases of liver complications, liver-related mortality, and associated costs to compare ReLink-C to no intervention. In total, 1591 HCV-RNA positive individuals were identified during the overall study period; 914 were selected for retrieval and 166 for contact. After 5 calls, 104 individuals were located and 51 agreed to a visit. Ultimately, 41 started and completed DAA treatment. During the COVID-19 period, 70% of patients were selected for retrieval vs 51% in pre-COVID (p<0.0001), but a smaller percentage were located (p<0.005). The ReLink-C strategy cost was €26,075. Over a lifetime horizon, ReLink-C avoided 11 cases of decompensated cirrhosis, 7 hepatocellular carcinoma, and 1 liver transplant: cost saving €456,796. Deaths were reduced by 26%. In conclusion, the Relink-C approach enabled retrieval and treatment of a large number of LTFU patients and proved to be cost-effective. A larger number of patients needed to be linked to care and treatment during the COVID 19 pandemic than before.