Cost-effectiveness of several antiviral treatment strategies in HCV patients in Egypt

While treating 40 000 patients per year in the National Treatment Program is a great achievement, it represents less than 1% of the 6 million Egyptians with chronic hepatitis C. One major question for the Egyptian government is how to best select the 40 000 patients to treat? Should we treat “early” cases (e.g. F1), with high virological response rates, but who are unlikely to develop complications soon if ever, and who may benefit from the better and safer treatments that will be available in the future? Or should we treat patients with advanced disease (e.g. F3 and compensated F4), who have poorer response rates, but who would surely develop complications in the near future? Analysis of the NHTMRI data showed that more than 50% of patients were F1. There were no F4 patients, even compensated, because of the current guidelines of the National Treatment Program. We therefore turned to cost-effectiveness analysis to answer this question.


This study evaluated different treatment strategies in simulated Egyptian patients with chronic hepatitis C, aged 18 to 60 years old, infected with a genotype 4 virus, who are not at a decompensated cirrhosis stage, who were not co-infected with either schistosomiasis, HIV or HBV, and who were naïve to treatment. Several strategies, including the one currently used in the National Treatment Centres, were tested using different criteria to initiate and to stop treatment. A model of the natural history of HCV to assess the clinical benefits and costs associated with various treatment strategies in the Egyptian setting was developed. Only direct medical costs were considered (Egyptian government perspective). Model outcomes were the number of decompensated cirrhosis and HCC, life expectancy, quality-adjusted life expectancy, and lifetime costs for a representative cohort of HCV-infected individuals. Strategies were compared using incremental cost-effectiveness ratios, expressed as $US per year of life saved. Future costs and clinical benefits were discounted at 3% per year. Extensive sensitivity analysis were conducted to address parameter uncertainty and to evaluate the impact of alternative modelling assumptions.


Note: This study has been completed and results will be updated here soon.


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fp7_01fp7_02 This project is funded
by the European Union