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

Table 1 Evaluated scenarios for projections of the future burden of hepatitis C infection in Greece

Scenario	Year	SVR	Treatment coverage/yr	Fibrosis stage	Diagnosed patients/yr
Base case	2015-2016	90%-95%	~1000	≥ F3	4000
	2017-2019	95%	~2000	≥ F2	3200
	2020-2021	95%	~1300	≥ F2	2000
	2022-2023	95%	~1000	≥ F2	1400
	2024-2035	95%	~1000	≥ F2	1000
WHO Global Hepatitis Strategy	2015-2016	90%-95%	~1000	≥ F3	4000
	2017-2019	95%	~4700	≥ F2	4800
	2020-2021	95%	~6800	≥ F0	6820
	2022-2023	95%	~6800	≥ F0	6130
	2024-2035	95%	~7000	≥ F0	6130

SVR: Sustained virologic response rates; WHO: World Health Organization.

Table 2 Annual direct costs per patients in Euros

	Annual costs, €
Lab costs for anti-HCV, RNA test, genotyping exam and liver biopsy/elastography	350
Screening cost per screen	101
Cost per diagnosed patient without antiviral treatment
F0-F3	230
Compensated cirrhosis, F4	1340
Decompensated cirrhosis	4460
Hepatocellular carcinoma	33000
Liver transplantation	1346002
Liver transplant - subsequent years	4600
Antiviral treatment costs of DAAs
2015-2016	42000
2017-2023	13000
2024-2035	13000/85003

¹Cost per screen;

²Cost per patient for one time (includes all pre-transplantation, transplantation and post-transplantation courses);

³Under optimistic price reduction scenario. DAAs: Direct-acting antivirals; HCV: Hepatitis C virus.

Table 3 Estimated number of total hepatitis C virus infected (viremic cases), compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma cases in 2030 and 2035 under base and hepatitis C virus elimination scenarios

	2015, Base n	2020, n (% change compared to 2015)	2030, n (% change compared to 2015)	2035, n (% change compared to base case in 2015)
	Base case
Total infected	132500	127940 (-3.4)	121460 (-8.3)	117750 (-11.1)
Compensated cirrhosis	17700	18584 (+4.9)	21100 (+19.2)	21280 (+20.2)
Decompensated cirrhosis	1830	1885 (+3.0)	2160 (+18.3)	2200 (+20.2)
HCC	590	605 (+2.5)	705 (+19.4)	710 (+20.3)
Liver related deaths	660	686 (+3.9)	790 (+19.6)	805 (+21.9)
	WHO Global Hepatitis Strategy
Total infected		107910 (-18.5)	28000 (-78.8)	2100 (-98.4)
Compensated cirrhosis		13584 (-23.2)	6480 (-63.3)	1084 (-93.9)
Compensated cirrhosis		1155 (-36.9)	610 (-66.7)	160 (-91.2)
HCC		395 (-33.0)	195 (-66.9)	30 (-94.9)
Liver related deaths		415 (-37.2)	226 (-65.7)	57 (-91.4)

HCC: Hepatocellular carcinoma; WHO: World Health Organization.

Table 4 Direct costs by price reduction scenario in billions of euros, disability-adjusted life years and incremental cost-effectiveness ratios

	Base case		HCV elimination strategy
			Optimistic			Conservative
Years	Direct cost (billion euros)	DALYS	Direct cost (billion euros)	DALYS	ICER (compared to base case)	Direct cost (billion euros)	DALYS	ICER (compared to base case)
2015-2030	1.46	145.920	2.12	80.920	10.100 €	2.33	80.920	13.400 €
2015-2035	1.88	187.470	2.41	84.250	5.100 €	2.74	84.250	8.300 €

HCV: Hepatitis C virus; DALYs: Disability-adjusted life years; ICER: Incremental cost-effectiveness ratio.