Costs of Delivering the Hep B PAST Model of Care in Remote Australia: A Retrospective Pre–Post Study

OBJECTIVES: To estimate the direct medical costs of the Hep B Partnership Program (Hep B PAST) model of care compared with chronic hepatitis B (CHB) usual care from the health system perspective (Northern Territory (NT) Department of Health and the Commonwealth). STUDY TYPE: Retrospective cohort study (2014-2023) that linked primary care with inpatient, emergency, outpatient and outreach datasets. Costs were applied using National Weighted Activity Units, the Pharmaceutical Benefits Scheme and NT Government costings. A pre- and post-implementation design from a health system perspective was applied, with costs in 2023 Australian dollars. SETTING: Remote communities in the NT, Australia. PARTICIPANTS: The cohort included all First Nations people living with CHB who were attending a clinic in a remote community that had consented to the Hep B PAST program, and who received care between 1 July 2014 and 31 May 2023. MAIN OUTCOME MEASURES: Annual mean and median healthcare costs per contact and per individual across service types, with comparisons of annual mean costs per individual between pre- and post-Hep B PAST using partially overlapping t-tests. RESULTS: Among 1063 First Nations individuals with CHB, annual median costs per individual were similar for usual care ($639 [interquartile range, $366-1156]) and Hep B PAST ($770 [interquartile range, $400-1272]); mean costs were also similar for usual care versus Hep B PAST ($1701 vs. $1970; p = 0.12). By service type, annual median costs were similar for inpatient services ($7777 vs. $7795), primary care ($327 vs. $302) and outpatient visits ($1985 vs. $1858), and higher for Hep B PAST for emergency services ($1339 vs. $1672) and outreach care ($373 vs. $746). CONCLUSIONS: In remote First Nations communities, Hep B PAST was delivered with a modest increase in direct medical costs compared with usual care. These findings can be used to inform future cost-effective evaluations. Future cost savings from decreased hepatocellular carcinoma and liver failure were not included.