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Projections of the Healthcare Costs and Disease Burden due to Hepatitis C Infection under Different Treatment Policies in Malaysia, 2018–2040

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Abstract

Introduction

The World Health Organisation (WHO) has set ambitious goals to reduce the global disease burden associated with, and eventually eliminate, viral hepatitis.

Objective

To assist with achieving these goals and to inform the development of a national strategic plan for Malaysia, we estimated the long-term burden incurred by the care and management of patients with chronic hepatitis C virus (HCV) infection. We compared cumulative healthcare costs and disease burden under different treatment cascade scenarios.

Methods

We attached direct costs for the management/care of chronically HCV-infected patients to a previously developed clinical disease progression model. Under assumptions regarding disease stage-specific proportions of model-predicted HCV patients within care, annual numbers of patients initiated on antiviral treatment and distribution of treatments over stage, we projected the healthcare costs and disease burden [in disability-adjusted life-years (DALY)] in 2018–2040 under four treatment scenarios: (A) no treatment/baseline; (B) pre-2018 standard of care (pegylated interferon/ribavirin); (C) gradual scale-up in direct-acting antiviral (DAA) treatment uptake that does not meet the WHO 2030 treatment uptake target; (D) scale-up in DAA treatment uptake that meets the WHO 2030 target.

Results

Scenario D, while achieving the WHO 2030 target and averting 253,500 DALYs compared with the pre-2018 standard of care B, incurred the highest direct patient costs over the period 2018–2030: US$890 million (95% uncertainty interval 653–1271). When including screening programme costs, the total cost was estimated at US$952 million, which was 12% higher than the estimated total cost of scenario C.

Conclusions

The scale-up to meet the WHO 2030 target may be achievable with appropriately high governmental commitment to the expansion of HCV screening to bring sufficient undiagnosed chronically infected patients into the treatment pathway.

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Acknowledgements

The authors thank Lindsey Hiebert at Pharos Global Health for kindly using their developed tool to estimate the screening programme cost for scenario C.

Author information

Author notes

    Authors and Affiliations

    1. Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia

      Scott A. McDonald & Adeeba Kamarulzaman

    2. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

      Scott A. McDonald

    3. School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland

      Scott A. McDonald

    4. Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

      Amirah Azzeri, Fatiha Hana Shabaruddin, Adeeba Kamarulzaman & Rosmawati Mohamed

    5. Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

      Maznah Dahlui

    6. Faculty of Public Health, University of Airlangga, Surabaya, Indonesia

      Maznah Dahlui

    7. Department of Hepatology, Selayang Hospital, Lebuhraya Selayang-Kepong, Malaysia

      Soek S. Tan

    Authors
    1. Scott A. McDonald
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    Contributions

    FHS, MD and RM conceived the study. SAM implemented the HCV progression model, carried out the simulations, and drafted the manuscript. AA conducted the costing study and calculated disease-stage specific direct costs. SAM, AA, FHS, MD, SST, AK, RM contributed to the writing of the final manuscript.

    Corresponding author

    Correspondence to Scott A. McDonald.

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    Ethical approval

    Ethical approval was not required for this modelling study.

    Funding

    No sources of funding were used to conduct this study or prepare this manuscript.

    Conflicts of interest

    SAM, AA, FHS, MD, SST, AK, and RM have no conflicts of interest.

    Additional information

    Scott A. McDonald and Amirah Azzeri are joint first author.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (PDF 628 kb)

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    Cite this article

    McDonald, S.A., Azzeri, A., Shabaruddin, F.H. et al. Projections of the Healthcare Costs and Disease Burden due to Hepatitis C Infection under Different Treatment Policies in Malaysia, 2018–2040. Appl Health Econ Health Policy 16, 847–857 (2018). https://doi.org/10.1007/s40258-018-0425-3

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    • DOI: https://doi.org/10.1007/s40258-018-0425-3

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