PTH-086 Virtual hepatitis B clinics significantly improve cost and clinical effectiveness

Abstract

Introduction Chronic Hepatitis B (HBV) infection requires regular hepatology review to assess for potential flares, need for therapy and/or progression to advanced liver disease and its complications. The majority of patients are chronic carriers who feel perfectly well and can find repeated clinic visits difficult, unnecessary and impinge on other commitments (e.g. employment, social and child care). As a Result there is a high rate of missed appointments and or patients lost to follow up, with the potential for missed viral flares. A nurse-led virtual clinic allows remote monitoring of these patients as recommended by national and international guidelines.1 2 Methods Patients with stable chronic HBV suitable for telephone clinic follow-up were identified. The criteria used were: not on/received HBV therapy, no significant comorbidities or risk factors for liver disease, low viral load ( Over a 2.5 year period from 01.02.2014, patients meeting the criteria were offered 6-monthly virtual clinic review. Patients had surveillance blood test within 4 weeks of their apportioned telephone review to discuss Results and/or symptoms. As per NICE guidance annual Fibroscan was organised through a dedicated clinic. If any clinical and/or biochemical concerns arose a face-to-face review in clinic is arranged. Results Over this period 45 patients received 6-monthly virtual HBV clinic review. Bloods showed a median peak ALT 36 u/L (0–41 u/L), median viral load 62 iu/ml. and median AFP 2.7. Only 3/45 required face-to-face follow up due to a possible flare, with 2/45 eventually requiring an antiviral agent (Tenofovir). No patients required admission and/or access to other acute and/or community services due to their liver disease during this period. The cost savings were considerable. 6 monthly reviews in a face-to-face clinic over the 2.5 year period would have cost an estimated £27 636. The cost of running a virtual telephone clinic for the same period was £5,517; a saving of 501%. There were only 5 missed blood tests ahead of the clinic appointment. This compares to the 22% DNA rate in our general hepatology clinics. Conclusions A nurse-led virtual clinic provides high-quality, cost-effective care to patients and improves HBV monitoring. Better compliance allows for detection of flares which could require antiviral treatment. With the prospect of new treatments on the horizon it is important these patients remain under the care of a hepatology team and a virtual clinic model allows them to remain engaged with Liver services.