Бремя вирусного гепатита С в зависимости от различных стратегических подходов в Тюменском регионе

Abstract

Hepatitis C virus (HCV) is a medical and socially meaningful problem. Economic burden caused by HCV-infection requires development of the prognostic concept model based on the analysis of different strategies within the regional Health Care System. Aim: to assess the results of dynamic modelling of social and epidemiological approaches using different strategies of medical assistance for HCV patients within the regional Health Care System in Tyumen region. Materials and methods: in this study the data from regional viral hepatitis registry were used along with the data from official statistics from Regional segment of Rospotrebnadzor of Tyumen region. For analysis of the epidemiological situation with HCV and economic outcomes of different treatment strategies Health Policy Model was used. Health Policy Model is based on the dynamic Excel table and was developed by CDA (Center for disease analysis). Results and discussion: there are 26411 patients in the regional viral hepatitis registry, including 11832 with HCV (45,3%). If the parameters described in the base scenario remain stable, the total number of HCV infected patients in the region will increase up to 136 887, 370 patients will die due to the reasons related to liver disease, the number of patients with decompensated cirrhosis will increase up to 1006 by 2030 (compared with 371 in 2017), the number of HCC cases will increase up to 339 by 2030 (compared with 135 in 2017). Indicators of total mortality will increase from 3317 cases in 2017 to 4154 in 2030. In case of implementation of the strategy with gradual increase of access to HCV treatment up to 600 patients per year will lead to 20% HCV-related mortality decrease, 19% deсline is expected for HCC and 20% decrease of number of patients with decompensated cirrhosis, in addition the total number of HCV infected patients will decline to 30007. Using this scenario, we expect not so dramatic increase of expenses for antiviral treatment as in case of the WHO scenario. At the same time, it leads to decline in expenses allocated for nontreated patients, owing to which 4,9 billion rubles released can be considered as a savings and can be spent on the antiviral treatment. The scenario of gradual broaden of access to antiviral treatment can be considered as a stage towards HCV elimination in the region and achievement of WHO goals in the future. Conclusion. Achievement of determined targets in Tyumen region seems feasible in case of optimization of current approaches, but requires significant resources, which can be received through the creation of regional HCV elimination strategy with broad access to direct antiviral agents (DDAs).