Economic evaluation of the Hepatitis C virus elimination program in the country of Georgia, 2015 to 2017

Abstract

Background and aims: In 2015, the country of Georgia launched an elimination program aiming to reduce the prevalence of Hepatitis C virus (HCV) infection by 90% from 5.4% prevalence (~150 000 people). During the first 2.5 years of the program, 770 832 people were screened, 48 575 were diagnosed with active HCV infection, and 41 483 patients were treated with direct-acting antiviral (DAA)-based regimens, with a >95% cure rate.

Methods: We modelled the incremental cost-effectiveness ratio (ICER) of HCV screening, diagnosis and treatment between April 2015 and November 2017 compared to no treatment, in terms of cost per quality-adjusted life year (QALY) gained in 2017 US dollars, with a 3% discount rate over 25 years. We compared the ICER to willingness-to-pay (WTP) thresholds of US$4357 (GDP) and US$871 (opportunity cost) per QALY gained.

Results: The average cost of screening, HCV viremia testing, and treatment per patient treated was $386 to the provider, $225 to the patient and $1042 for generic DAAs. At 3% discount, 0.57 QALYs were gained per patient treated. The ICER from the perspective of the provider including generic DAAs was $2285 per QALY gained, which is cost-effective at the $4357 WTP threshold, while if patient costs are included, it is just above the threshold at $4398/QALY. All other scenarios examined in sensitivity analyses remain cost-effective except for assuming a shorter time horizon to the end of 2025 or including the list price DAA cost. Reducing or excluding DAA costs reduced the ICER below the opportunity-cost WTP threshold.

Conclusions: The Georgian HCV elimination program provides valuable evidence that national programs for scaling up HCV screening and treatment for achieving HCV elimination can be cost-effective.

FIGURE 1

Care cascade of patients receiving positive anti-HCV test during the study period.

FIGURE 2

Cost of liver disease care over 25 years (2015–2039) to MOH only (green) or including the cost to patients and to MOH together (red), with (dashed line) and without (solid line) the scale-up in DAA treatment, in non-discounted 2017 USD.

FIGURE 3

Sensitivity analysis ‘tornado plot’ showing variation in ICER under different scenarios. Full DAA cost scenario not shown (ICER $136 052/QALY). The dashed line shows the WTP threshold of 1x GDP per capita, and the dotted line shows the alternative opportunity cost-based WTP threshold of 20% GDP per capita.