Abstract
ABSTRACT
Context:
American Indian and Alaska Native (AI/AN) people experience the highest rates of hepatitis C virus (HCV) infection and HCV-related mortality in the United States. However, access to HCV care remains limited in many tribal and rural communities. Telehealth models such as the Extension for Community Healthcare Outcomes (ECHO) have been used to expand access by supporting primary care providers in delivering complex treatments locally.
Objectives:
To assess the cost savings of implementing Cherokee Nation Health Services' (CNHS) HCV ECHO program compared with conventional, specialist-based care.
Design:
This modeling analysis compared estimated costs of conventional care and ECHO-supported care using CNHS financial records, internal accounting data, and publicly available cost estimates. Modeling methods are provided in more comprehensive detail in the appendix. HCV prevalence, treatment initiation, and sustained virologic response outcomes were derived from deidentified CNHS electronic medical record data from 2016 to 2020. Demographic projections were based on US Census data for the Cherokee Oklahoma Tribal Statistical Area to model HCV treatment outcomes by age and sex through 2040.
Study timeframe:
ECHO program between 2016 and 2020.
Main outcome measure:
Estimated cost per patient and projected cumulative cost savings over 10- and 20-year horizons.
Setting:
CNHS is the largest tribally operated health system in the United States, serving a predominantly AI/AN population in rural Oklahoma.
Participants:
Modeled patient population with diagnosed HCV infection in the CNHS service area. The average number of patients based on the CNHS data between 2016 and 2019 was 185, which was used as the 2010 base for the model.
Intervention:
Implementation of an HCV ECHO program beginning in 2014 to decentralize HCV treatment to primary care providers through case-based telehealth consultation and guided mentorship.
Results:
HCV care delivered via ECHO cost 69% less per patient than conventional specialist care ($1412 vs. $4534), yielding projected savings of $6.3 million over 10 years and nearly $10 million over 20 years.
Conclusions:
The CNHS HCV ECHO program demonstrates that telehealth-based models can deliver substantial cost savings while improving access to specialty-level care in rural and AI/AN communities.