text: Pilot grant awardee Dr. Karen Lasser and her team have developed an intervention to screen, link and treat patients with hepatitis C (HCV) in the primary care setting. As the founding medical director for HCV treatment in primary care, Dr. Lasser was motivated to do a budget impact analysis of their intervention to analyze whether the intervention would be sustainable at Boston Medical Center (BMC). She and her team recently presented preliminary results at the BMC Division of Infectious Diseases grand rounds. BMC is located at the epicenter of the HCV epidemic in Boston, and the BMC primary care practice patient population has an HCV prevalence that is eight times higher than the national average.
  The team found that progress along the HCV cascade of care in the clinic hinges on the efforts of a case manager, who identifies and addresses patient needs and barriers to care, and a pharmacy technician who completes the prior authorization process. In order to assess the financial consequences of implementing the intervention, Dr. Lasser and her team used a “cost calculator” approach to conduct a budget impact analysis of personnel costs, billable services and other expenses. Dr. Lasser did not have experience conducting budget impact analysis prior to receiving her pilot grant, but she explains that the team chose to use this method because “it gives more practical information to budget holders, stake holders and decision makers by communicating how much revenue the intervention can bring in as well as how much it costs, as well as information about the outcomes.”
  During her presentation, Dr. Lasser explained that many patients in the BMC primary care practice were obtaining HCV medications at the onsite pharmacy through a 340B pharmacy benefit program. She cautioned that “if the 340B program ends, the intervention will no longer drive revenue and instead there will be a cost associated with the program.” This would affect the sustainability and replication in similar primary care settings, which would be largely dependent on whether the institution could invest resources. She goes on to say that “it might be possible to implement a paired down version of the intervention which is more affordable, because not everyone needs the full list of services and support from the case manager.”