Chandraprakash Umapathy, MD, MS
Gastroenterology and Hepatology Fellow
University of California San Francisco Fresno
Fresno, California
Chandraprakash Umapathy, MD, MS1, Jonathan Pham, DO, MPH1, Linda Stokes, PhD2, Marina Roytman, MD1
1University of California San Francisco - Fresno, Fresno, CA; 2Community Regional Medical Center, Fresno, CA
Introduction: In 2015, 40,326 or 12.5 per 100,000 population died from chronic liver disease. Viral hepatitis is associated with 18.5% of chronic liver disease related deaths. The vast majority of patients with liver disease present in the chronic phase, however, Community Regional Medical Center was using an acute hepatitis panel (HAV Ab IgM, HBsAg, HBcAb IgM, and HCV Ab) to evaluate for viral hepatitis. We created and implemented a chronic hepatitis panel (HAV Ab Total, HBsAg, HBsAb, HBcAb Total, and HCV Ab) with the aim of improving screening for chronic viral hepatitis, identifying patients at risk for HBV reactivation and patients in need for HAV and HBV vaccinations.
Methods: Baseline clinical and laboratory data including the number of acute hepatitis panels were collected from July 2017 to June 2018. Post-implementation data were collected from November 2018 to April 2019. The primary outcome was the utilization of the appropriate hepatitis panel to the presenting clinical syndrome. Secondary outcomes were vaccination rates for HAV and HBV in the setting of chronic liver disease and healthcare cost utilization of patients with chronic liver disease.
Results: Of 17,357 patients screened, acute hepatitis panel was ordered in 40.2%, mainly in the emergency department (42%) and inpatient (40%) setting. Of these, 26.9% of acute hepatitis panels were ordered with ALT < 150 or prior to ALT results. 64.7% of patients completed chronic hepatitis panel components afterward. Chronic hepatitis panel components were ordered more than once in 47.4%. Post-implementation data was collected in 6298 patients of which, 14% completed the chronic hepatitis panel. There was a 220% increase in the number of chronic hepatitis panels ordered, from November 2018 to April 2019. The average number of hepatitis labs (panel or components) ordered per patient decreased from 3.4 to 2.2 post implementation of the chronic panel. The cost for the chronic hepatitis panel is $214.20 compared to $325.38 for the acute hepatitis panel, reflecting a cost savings of 34% per panel. This is in addition to the projected savings from the decrease in the inappropriate ordering of labs.
Discussion: The chronic hepatitis panel can improve screening for chronic viral hepatitis, and potentially improve vaccination rates against Hepatitis A and Hepatitis B, as well as help prevent HBV reactivations, while lowering costs, in chronic liver disease. Longitudinal studies are needed to assess the impact of chronic hepatitis panel on disease outcomes.
Citation: Chandraprakash Umapathy, MD, MS; Jonathan Pham, DO, MPH; Linda Stokes, PhD; Marina Roytman, MD. P1548 - IMPLEMENTATION OF A CHRONIC HEPATITIS PANEL TO IMPROVE VIRAL HEPATITIS SCREENING IN CHRONIC LIVER DISEASE. Program No. P1548. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.