Background

Methodology

Objective

Methods

References

Conclusion

Disclosures

Methods

Future Economic Burden of Hepatitis C in Egypt: Impact of Treatment Strategies

Estes C 1, Razavi H 1, Waked I 2

1 Center for Disease Analysis (CDA), Louisville, CO, USA, 2 National Liver Institute, Menoufiya, Egypt

� Chronic HCV infection is the leading cause of cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation in Egypt (1).� There are continued high levels of HCV transmission and chronic HCV

infection in Egypt (2).� The introduction of highly efficacious therapies has the potential to markedly

reduce disease burden.� The economic impact of different management scenarios need to be

accurately projected and projections can inform policymakers to allow better allocation of resources to reduce HCV prevalence and burden.

� Use a modeling approach to consider the economic impact of three scenarios:

1) Scenario 1: Base case 2) Scenario 2: Increased treatment efficacy 3) Scenario 3: Increased treatment, diagnosis & reduced new infections

� Costs from HCV-related disease are increasing in Egypt, especially costs attributable to advanced liver disease and liver-related deaths.� This study will facilitate disease forecasting, resource planning, and rational

strategies for HCV management in Egypt. � The results of Scenario 2 demonstrate that increased treatment efficacy

alone has the potential to modestly reduce HCV-related cost burden. � The results of Scenario 3 demonstrate that extraordinary measures are

necessary in Egypt to substantially reduce cases of advanced liver disease.

C. Estes and H. Razavi are employees of the Center for Disease Analysis (CDA); I. Waked: Speaker: Roche, Merck, BMS, GSK, Bayer, Gilead, Minapharm, Advisory Board: Janssen, Roche, Merck, Novartis, GSK, Minapharm, Evapharm. Investigator in clinical trials: Roche, BMS, GSK, Bayer.

Scenario 2 (Increase Efficacy Only)� Annual YLDs and YLLs in 2030 decline by 18% and 43%

as compared to the base case (Figures 2a and 2b).� Annual DALYs in 2030 decline by 29% as compared to

the base case (Figure 2c).� Annual direct and indirect costs in 2030 decline by 16%

and 29% as compared to the base case (Figures 3a and 3b). � Annual total costs in 2030 decline by 27% in 2030 as

compared to the base case (Figure 3c). Scenario 3 (Increase Efficacy and Treatment) � Annual YLDs and YLLs in 2030 decline by 72% and 87%

as compared to the base case (Figures 2a and 2b).� Annual DALYs in 2030 decline by 79% as compared to

the base case (Figure 2c).� Annual direct and indirect costs in 2030 decline by 17%

and 79% as compared to the base case (Figures 3a and 3b). � Annual total costs in 2030 decline by 65% in 2030 as

compared to the base case (Figure 3c).

� A disease progression model was utilized to forecast the change in disease burden over time (3).� Direct healthcare costs were calculated for each disease state from a

nationally representative government hospital and used to calculate annual direct costs attributable to HCV. � Using the WHO’s disability adjusted life year (DALY) template (4), calculated

years of living with disability (YLD), years of life lost (YLL) due to early mortality, and annual indirect costs.� Examined the cost of strategies of reducing new infections and increasing

treatment and SVR with a shift to second-generation direct antivirals.Scenario 1 (Base Case)� Held 2013 assumptions constant through 2030: � 168,620 new HCV infections occur in Egypt, and 65,000 cases are treated

annually. Proportion of patients diagnosed and under care remain constantScenario 2 (Increase Efficacy Only) � Examine impact of increased sustained virologic response (SVR) rates and

treatment eligibility (Figure 1).Scenario 3 (Increase Efficacy and Treatment) � Strategy developed to reduce prevalence to <2% by 2015 and reduce the

prevalent population by at least 90% by 2030.� Examine impact of increased SVR and treatment eligibility along with substantial

increases in the annual treated and diagnosed populations (Figure 1).

Egypt_Scen2b 2020-2030Egypt_Scen2bScenarios 2 and 3

SVR

& Eligibility

SVR Eligibility

2020-2030

Scenario 3 only

Increase Annual Treatedand Diagnosed

Treated Diagnosed

2013 2014-2015 2016-2017 2018-2019

2018-20192013 2014-2015 2016-2017

0%

20%

40%

60%

80%

100%

G1 G2 G3 G40%

20%

40%

60%

80%

100%

G1 G2 G3 G40%

20%

40%

60%

80%

100%

G1 G2 G3 G40%

20%

40%

60%

80%

100%

G1 G2 G3 G4

56,200

125,000

-

100,000

200,000

300,000

400,000

56,900

156,000

-

100,000

200,000

300,000

400,000

260,000

195,000

-

100,000

200,000

300,000

400,000 325,000

293,000

-

100,000

200,000

300,000

400,000

0%

20%

40%

60%

80%

100%

G1 G2 G3 G4

325,000 366,000

-

100,000

200,000

300,000

400,000

Figure 2. YLDs (a), YLLs (b), DALYs (c), by scenario – Egypt, 2013-2030

Figure 3. Direct costs (a), Indirect costs (b), Total costs (c), by scenario – Egypt, 2013-2030

Results

Figure 1. Assumptions for Scenarios 2 and 3 – Egypt, 2013-2030

(1) Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect 2011 Feb;17(2):107-15.

(2) El-Zanaty F, Way A. Egypt demographic and health survey, 2008. 431. 2009. Cairo, Cairo, Egypt : Ministry of Health and Population, 2009. Demographic and Health Survey (EDHS).

(3) Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat 2014 May;21 Suppl 1:34-59.

(4) Central Agency for Public Mobilization and Statistics, CAPMAS. Estimates of Midyear Population by Age Groups (2006-2012). 11-21-2013. 11-21-2013.

(5) Abdel-Hamid M, El-Daly M, Molnegren V, El-Kafrawy S, Abdel-Latif S, Esmat G, et al. Genetic diversity in hepatitis C virus in Egypt and possible association with hepatocellular carcinoma. J Gen Virol 2007 May;88(Pt 5):1526-31.

(6) Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology 2008 Aug;48(2):418-31.

(7) Personal Communication. Data from National Liver Institute. 8-26-2013. 8-26-2013. (8) Breban R, Doss W, Esmat G, Elsayed M, Hellard M, Ayscue P, et al. Towards realistic

estimates of HCV incidence in Egypt. J Viral Hepat 2013 Apr;20(4):294-6. (9) Miller FD, Abu-Raddad LJ. Evidence of intense ongoing endemic transmission of hepatitis

C virus in Egypt. Proc Natl Acad Sci U S A 2010 Aug 17;107(33):14757-62. (10) World Health Organization. Global Health Observatory. 11-21-2013. 11-21-2013. (11) UNAIDS: Joint United Nations Programme on HIV/AIDS. Middle East and North Africa:

Regional Report on AIDS 2011. 2011. (12) Elhawary EI, Mahmoud GF, El-Daly MA, Mekky FA, Esmat GG, Abdel-Hamid M.

Association of HCV with diabetes mellitus: an Egyptian case-control study. Virol J 2011;8:367.

(13) World Health Organization. Disability adjusted life years (DALY). 2014.

0

100,000

200,000

300,000

400,000

500,000

DAL

Ys

DALYs

Scenario 1 (Base Case)

Scenario 2 (Increase Efficacy Only)

Scenario 3 (Increase Efficacy and Treatment)

0

50,000

100,000

150,000

200,000

250,000

YLLs

YLLs

Scenario 1 (Base Case)

Scenario 2 (Increase Efficacy Only)

Scenario 3 (Increase Efficacy and Treatment)

0

50,000

100,000

150,000

200,000

250,000

YLD

s

YLDs

Scenario 1 (Base Case)

Scenario 2 (Increase Efficacy Only)

Scenario 3 (Increase Efficacy and Treatment)

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

Mill

ion

(USD

)

Indirect costs

Scenario 1 (Base Case)

Scenario 2 (Increase Efficacy Only)

Scenario 3 (Increase Efficacy and Treatment)

$0

$200

$400

$600

$800

$1,000

$1,200

Mill

ion

(USD

)

Direct costs

Scenario 1 (Base Case)

Scenario 2 (Increase Efficacy Only)

Scenario 3 (Increase Efficacy and Treatment)

$0 $500

$1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000

Mill

ion

(USD

)

Total costs

Scenario 1 (Base Case)

Scenario 2 (Increase Efficacy Only)

Scenario 3 (Increase Efficacy and Treatment)