Transcript Economic Impact of Eliminating HCV -- H. Razavi

Economic Impact of Eliminating HCV
H. Razavi
April 13, 2016
HCV Economic impact models have been developed for 15 countries/
regions
Africa
Ethiopia
Ghana
Nigeria
Americas
Mexico
British Columbia
Asia/ Pacific
Egypt
Japan
Malaysia
Mongolia
Saudi Arabia
Viet Nam
Europe
Croatia
Switzerland
Spain
Greece
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Methodology
•
Direct Costs
» Healthcare costs (outpatient, inpatient, medical cost excluding HCV treatment)
» Laboratory costs – screening, PCR, viral load, staging, genotyping, other
» Current and future cost of therapies (DAAs, Peg IFN, traditional medicine)
» Private vs. public
» Patient co-pay
•
Indirect Costs
» Years living with disability
» Years of life lost
» Converted to an economic value using gross national income (GNI) per capita for
ages
• Scenarios
» WHO recommendation / elimination
» Drop in generic drug prices over time
» Simplifying laboratory procedures
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Ethiopia Economic Impact Analysis - Assumptions
Diagnostic Costs - USD
Anti-HCV
RNA Test/ PCR
Genotyping
Staging/ Liver Biopsy/ Fibroscan
Annual Cost per Diagnosed Patient - USD
Public
Private
13
20
120
180
70
105
250
375
Public Cost
Private Cost
Annual Follow-up Cost (F0-F3)
601
857
Compensated Cirrhosis
685
1,028
Decompensated Cirrhosis
3,400
5,100
Hepatocellular Carcinoma
4,900
7,350
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Economic Impact of HCV Treatment – Direct Costs
Screening Cost - Total
18
80
16
70
Annual Cost (USD Millions)
Annual Cost (USD Millions)
Tx & Lab Costs - Total
14
12
10
8
6
4
2
60
50
40
30
20
10
-
-
Base
Base
WHO Elimination
Total Direct Costs
Healthcare Costs - Total
250
200
180
Annual Cost (USD Millions)
Annual Cost (USD Millions)
WHO Elimination
160
140
120
100
80
60
40
20
200
150
100
50
-
-
Base
WHO Elimination
Base
WHO Elimination
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Economic Impact of HCV Treatment – Direct & Indirect Costs
DALYs
18
40,000
16
Annual Cost (USD Millions)
45,000
35,000
30,000
DALYs
Total Indirect Costs
25,000
20,000
15,000
10,000
5,000
-
14
12
10
8
6
4
2
-
Base
WHO Elimination
Base
Total Direct & Indirect Costs
Cumulative Total Direct & Indirect Costs
250
7,000
Annual Cost (USD Millions)
Annual Cost (USD Millions)
WHO Elimination
200
150
100
50
-
6,000
5,000
4,000
3,000
2,000
1,000
-
Base
WHO Elimination
Base
WHO Elimination
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Breakeven analysis - Ethiopia
Cumulative ROI - Direct & Indirect
400%
300%
Breakeven
ROI
200%
100%
0%
-100%
-200%
WHO Elimination
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In every country we have analyzed, treatment is more cost saving than
status quo
Egypt (Total Direct & Indirect Costs)
Mongolia (Total Direct & Indirect Costs)
Total costs
Total Cost
$9,000
$7,000
200,000
Status Quo in 2014
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
Annual Cost (M MNT)
Million (US Dollars)
$8,000
180,000
Status Quo in 2015
160,000
140,000
120,000
100,000
80,000
60,000
40,000
Elimination
Elimination
20,000
-
$0
Base
Reduce LRD
Min LRD / Elimin
Estes C, Abdel-Kareem M, Abdel-Razek W, Abdel-Sameea E, Abuzeid M, Gomaa A, et al. Economic burden of hepatitis C in Egypt: the future
impact of highly effective therapies. Aliment Pharmacol Ther 2015 Jul 22.
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This is not limited to low & middle income countries – in high income
countries the healthcare costs & cost per life year is higher
Saudi Arabia
Cumulative Total Direct & Indirect Costs
Cumulative ROI - Direct & Indirect
240%
180,000
160,000
190%
140,000
Breakeven
120,000
ROI
Annual Cost (Riyal Millions)
200,000
100,000
80,000
140%
90%
60,000
40,000
40%
20,000
-
-10%
Base
Elimination
Elimination
Cumulative Total Direct Costs
Cumulative ROI - Direct Costs
200%
160,000
150%
140,000
Breakeven
120,000
100%
100,000
ROI
Annual Cost (Riyal Millions)
180,000
80,000
50%
60,000
40,000
0%
20,000
-
-50%
Base
Elimination
Elimination
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Negotiating drug prices is important, but the central issue facing HCV
elimination is how to pay for it now & recover investment later
Mongolia
Minimize LRD / Elimination w Co-Pay
20%
Current spending on Treatment of HCC & Cirrhosis & Diagnosis
18%
Percent of Budget
16%
14%
12%
10%
8%
6%
4%
2%
0%
% of Public Health Insurance (2015)
% of Public Health Budget (2015)
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Conclusions:
• 60% of all HCV infected individuals can have access to generic DAAs
TODAY
• We need good healthcare and diagnostic costs to estimate the
economic burden of HCV and cost effectiveness of drugs and
diagnostics
• The laboratory/ testing requirements for HCV treatment need to be
simplified, simplified, simplified
• The cost of diagnostics needs to be examined closely in low income
countries
• Central issue facing HCV elimination is how to pay for it now & recover
investment later
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