The economic model of costs for realization of health care strategy for hepatitis C in the Republic Sakha (Yakutia)

Abstract

Hepatitis C is a significant medical problem threatening public health worldwide. In recent years, the Russian Federation has been developing a national program to combat viral hepatitis, and measures have been initiated to implement it.

The aim – to assess the cost-effectiveness of the healthcare system for chronic hepatitis C in the Republic of Sakha (Yakutia), depending on the strategy of medical care.

Material and methods. The work uses the materials of the official statistics of the Rospotrebnadzor for Republic of Sakha (Yakutia) and information from the register Chronic viral hepatitis in Republic of Sakha (Yakutia). To assess the burden of HCV, a dynamic model of morbidity progression developed by the Center for Disease Analysis (USA) was used.

Results. 2 scenarios of the development of the situation with HCV in the Republic of Sakha (Yakutia), different from the baseline, were analyzed with an assessment of their economic parameters. If the WHO scenario is implemented by 2030 in the republic, it is possible to reduce the total mortality from hepatitis C by 65%, reduce the number of patients with liver cancer by 66%, and with decompensated cirrhosis by 66%. This will reduce the overall incidence of HCV in Yakutia by 34% due to a significant reduction in the number of new cases of infection. When implementing scenario 1 with an increase in the number of patients receiving therapy per 100 people annually (from 334 in 2018 until 1534 in 2030), the epidemic situation is expected to improve due to: a decrease in mortality from liver diseases (by 24%) and HCC (by 26%); a decrease in the number of patients with decompensated cirrhosis (by 24%); a decrease in the total number of infected (by 22%).

As the economic calculations have shown, the strategy proposed by WHO is the most appropriate of the strategies considered. The implementation of the basic scenario at its minimum cost will not lead to a change in the epidemic situation in the Republic of Sakha (Yakutia). Scenario No. 1 is maximally costly in terms of the cost of antiviral therapy of HCV (Cost of Strategy), however, it is more economical for the healthcare system (Net Cost) as a whole, which is associated with a significant increase in the coverage of therapy and a decrease in the number of patients with advanced stages of liver disease.

Conclusion. For a significant change in epidemiological indicators for hepatitis C in the long term, it is not enough to increase the coverage of therapy alone. According to the WHO scenario, measures aimed at screening and increasing the detection of infection should be strengthened in parallel, which is the most rational both in terms of financial costs for its implementation and the impact on epidemiological indicators for HCV infection by 2030.

Keywords:chronic hepatitis C; cirrhosis; liver cancer; health care strategy; prognostic model; antiviral treatment coverage; economic efficiency; Yakutia

Funding. The creation of the Health Policy Model was carried out with the support of Gilead Sciences Russia.

Conflict of interest. The authors declare that there is no conflict of interest.

Contribution. The concept and design of the study – Sleptsova S.S., Ivanets Yu.I.; collection and processing of the material – Semenova V.K.; statistical processing – Ivanets Yu.I.; writing of the text – Sleptsova S.S.; material processing, editing – Sleptsov S.S.

Acknowledgments. The model used in the work was developed by the CDA organization. The details of the model were published earlier: Black S., Zazem S., Manns M., Altraif I., Duberg A.S., Muljono D. H., et al. Global prevalence and genotype distribution of hepatitis C viral infection in 2015: a model study. Lancet Gastroenterol Hepatol. 2017; 2 (3): 161–76.

For citation: Sleptsova S.S., Ivanets Yu.I., Sleptsov S.S., Semenova V.K. The economic model of costs for realization of health care strategy for hepatitis C in the Republic Sakha (Yakutia). Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2022; 11 (3): 104–11. DOI: https://doi.org/10.33029/2305-3496-2022-11-3-104-111

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CHIEF EDITOR
Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

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