Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals

BACKGROUND: Hepatitis C virus (HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral (DAA) treatment coverage, to compute the total costs (including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.

AIM: To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.

METHODS: A previously validated mathematical model was adapted to the Greek HCV-infected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs (direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.

RESULTS: Without the implementation of awareness or screening campaigns, approximately 20000 patients would be diagnosed and treated with DAAs by 2030. This strategy would result in a 19.6% increase in HCV-related mortality in 2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by 78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros (euro) by 2030, while the indirect costs would be euro 1.1 billion. The total elimination cost in Greece would range from euro 3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between euro 10100 and euro 13380, indicating that the elimination strategy is very cost-effective. Furthermore, HCV elimination strategy would save euro 560-895 million by 2035.

CONCLUSION: Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.

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Full citation:
Gountas I, Sypsa V, Papatheodoridis G, Souliotis K, Athanasakis K, Razavi H, Hatzakis A (2019).
Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals
World Journal of Gastroenterology, 25 (11), 1327-1340. doi: 10.3748/wjg.v25.i11.1327. PMCID: PMC6429341.