Managing Hepatitis C Patients in Greece: A Budget Impact Analysis of Simeprevir plus Pegylated Interferon/Ribavirin Regimen at Early Stages of the Disease

Mary Geitona,Themistoclis Vasiliadis,Spyridon Dourakis,Dimitrios Christodoulou,George Papatheodoridis,Spilios Manolakopoulos,Aris Lathouris,Charalabos Gogos,Ioannis Goulis,Alexandra Papadokostopoulou,Ioannis George Koskinas,Hara Kousoulakou

doi:10.4236/health.2017.911109

Abstract

Objectives: To identify local resource use such as pharmaceutical treatment, medical follow-up, and patient hospitalization and estimate the budget impact of simeprevir (SMV) plus pegylated interferon (P)/ribavirin (R) as a treatment option in the early stages of the disease in Greece. Methods: A budget impact tool was developed with a two-year time horizon, which estimated the impact on the Social Insurance Funds (SIFs) of introducing SMV + PR in the management of the early disease stages. Total direct and indirect costs were estimated for each of the following health states: non-cirrhotic chronic Hepatitis C (and within that by fibrosis stage), compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma. Data gaps on treatment algorithms, resource use and productivity losses were covered via an expert panel of eight leading hepatologists. Epidemiology data were taken from the published literature. Unit costs were obtained from the Ministry of Health and SIFs. The perspective was that of the SIF and the cost base year was 2015. Results: The total (direct and indirect) cost per patient per year (excluding cost of antiviral treatment) was estimated at �47, �03, �,753, �6,313 and �7,237 for non-cirrhotic CHC, compensated cirrhosis, decompensated cirrhosis, HCC and liver transplantation, respectively. The budget impact analysis showed that adding SMV to PR in the early stages of the disease would lead to an increase in the cost of antiviral treatment by �.03 million. Conclusions: Costs of managing CHC increase dramatically with disease severity. SMV + PR for naive patients at early disease stages has a significant but manageable budget impact, and could prevent high costs in advanced stages.

Highlights

Hepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer [1]
A budget impact tool was developed with a two-year time horizon, which estimated the impact on the Social Insurance Funds (SIFs) of introducing SMV + PR in the management of the early disease stages
15% - 25% of HCV infections are estimated to progress to severe liver disease, which may take more than 30 years to develop [4] [5]

Summary

Introduction

Hepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer [1]. 15% - 25% of HCV infections are estimated to progress to severe liver disease, which may take more than 30 years to develop [4] [5]. HCV-specific burden of disease data for Europe are scarce [2]. An estimated 7.3 - 8.8 million people (1.1% - 1.3%) are infected in Europe. The exact prevalence of HCV infection in Greece is not well known [6], it is estimated that approximately 1.5% - 2% of the general population have chronic HCV infection with a wide geographical variance of seropositivity (0.5% - 7.5%) [7] [8] [9] [10] [11]. The epidemiology of the disease is changing owing to immigrants and intravenous drug users [12]

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