Economic Evaluation of Different Organizational Models for the Management of Patients with Hepatitis C

  • Stefano Fagiuoli U.O.C. Gastroenterologia - Epatologia e Trapiantologia - ASST Papa Giovanni XXIII - Bergamo
  • Luisa Pasulo U.O.C. Gastroenterologia - Epatologia e Trapiantologia - ASST Papa Giovanni XXIII - Bergamo
  • Franco Maggiolo U.O.C. Malattie Infettive – ASST Papa Giovanni XXII - Bergamo
  • Rosaria Spinella Medicina Istituti Ospedalieri Bergamaschi - Bergamo
  • Paolo Del Poggio Medicina Istituti Ospedalieri Bergamaschi - Bergamo
  • Roberto Boldizzoni U.O.C. Medicina ASST Bergamo Ovest – Treviglio (Bg)
  • Mariella Di Marco U.O.C. Medicina A.S.S.T. Bergamo Est - Ospedale "Bolognini" – Seriate (Bg)
  • Alessandro Aronica Tefen & Partners Management Consulting
  • Chiara Benedetti Tefen & Partners Consulting
  • Paolo Correale Tefen & Partners Consulting
  • Chiara Garavaglia Tefen & Partners Consulting
  • Carlo Nicora Tefen & Partners Consulting
Keywords: Hepatitis C, Italy, Models, Organizational, Antiviral Agents, DAA, HCV, Hub & Spoke, Center of Excellence


BACKGROUND: Access to Directly Acting Antivirals (DAAs) for Hepatitis C Virus (HCV) treatment in Italy was initially restricted to severe patients. In 2017, AIFA expanded access to all patients, to achieve elimination by 2030.

AIM: To investigate the impact of different hospitals’ organizational models on elimination timing, treatment capacity and direct costs.

METHODS: Most Regional healthcare systems in Italy deploy a Center of Excellence (CoE) organizational model, where patients are referred to a single major hospital in the area, which is the only one that can prescribe and deliver DAAs. The study was conducted at Bergamo’s (Lombardy, Italy) Papa Giovanni XXIII hospital (PG-23), which deploys a Hub&Spoke model: the Hub (PG-23) prescribes and delivers DAAs while Spokes (four smaller hospitals) can only prescribe them. The study compares the two models (CoE vs. H&S). Patient journey and workloads were mapped and quantified through interviews with hospital stakeholders. Cost data were collected through the hospital’s IT system; the sample comprised 2,277 HCV patients, over one year.

RESULTS: The study calculated the average cost to treat HCV patients (~ € 1,470 per patient). Key cost drivers are lab tests (60%) and specialist visits (30%). Over one year, H&S can treat 68% more patients than CoE. As deferred patients absorb up to 40% of total costs, the “Optimized” model was designed by streamlining specialists’ visits and involving general practitioners during follow-up. “Optimized” model increases treatment capacity and reduces costs of deferred patients by 72% vs CoE.

CONCLUSION: The study demonstrates the importance of organizational models in efficiently achieving 2030 elimination.


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How to Cite
Fagiuoli, S., Pasulo, L., Maggiolo, F., Spinella, R., Del Poggio, P., Boldizzoni, R., Di Marco, M., Aronica, A., Benedetti, C., Correale, P., Garavaglia, C., & Nicora, C. (2019). Economic Evaluation of Different Organizational Models for the Management of Patients with Hepatitis C. Farmeconomia. Health Economics and Therapeutic Pathways, 20(1).
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