Impact of Different treatment rates for Hepatitis C Infected Patients on The Epidemiologic & Economic Burden In Egypt

Background: The burden of HCV infection in Egypt is one of the highest globally (estimated viremic cases at 6.5 million). New promising Hep C antiviral agents are more efficacious, but more costly, posing challenging policy questions related to rates of treatment and budget allocations. This analysis attempts to quantify the epidemiologic & economic impact of different treatment rates in Egypt. Methods: The analysis was based on a 17-year Markov state transition cohort with annual cycle lengths. At baseline, viremic patients were divided into 5-year age increments. Disease severity at baseline was modeled on the basis of data reported in the US, subsequently calibrated to match the 2013 prevalence of cirrhosis reported for Egypt. In the model, patients would then progressively through the various HCV stages from F0 to F3, based on international transition probabilities and were also at general population risk of death. Following the state of F3, patients could progress to hepatocellular carcinoma or cirrhosis. Following cirrhosis to other progressive stages up to hepatocellular carcinoma and liver related death. Patients could be cured spontaneously in state F0 or as a result of antiviral therapy in any state from F0 to cirrhosis at a cure rate of 92% in stages F0-F3 and a cure rate of 80% in the stage of cirrhosis. Cured patients would transition to the mortality risk of the age-matched general population. In each cycle, new incident patients were also introduced at a rate of approximately 128,000 or 2%. Results: The model indicates significant gains using the new antivirals when following a treatment rate of 8% (450K viremic cases/year) relative to a policy of 1% (65K cases/yr) or 5% (300Kcases/yr). By 2030 viremic cases would go down to 5.5, 2.5 and 1 million cases in the 1%, 5% and 8% treatment rate scenarios respectively. Similarly liver related deaths would similarly drop to 41,000 to 24,000 and 14,000 cases by 2030. Total annual costs would start at $1.3Billion in the first year of treatment in the 8% treatment rate pattern but decreases reaching an annual budget of $580million by 2030. Respectively 5% and 1% rates would start at $900million and $550million to go down to $600million and $500million by 2030. Conclusion. Treating patterns using the new antiviral Hep C agents from 300k/yr to 450k/yr would have a substantial clinical benefit. It would cost the society (government & private) more, in the short run, but eventually they would start running out of patients, so costs would go down. With 450k/year, Egypt could bring the Hep C prevalence down to 1% by 2030. Abstract