An estimated 71 million people are living with hepatitis C virus (HCV). It is a major cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. The elimination of HCV infection by 2030 is a stated objective made by the World Health Assembly. Important to this goal is the optimal utilization of resources, which requires a detailed understanding of the costs associated with curative therapy.
Treatment options for HCV infection have undergone a major transformation with the introduction of direct-acting antivirals (DAAs). These interferon-free regimens are highly effective and well tolerated, however the price of DAAs remains a barrier to treatment. This is where cost-effectiveness analysis can play a critical role in helping to elucidate how the investment of resources impacts long term outcomes.
Hep C Calculator is an interactive tool developed to evaluate the cost-effectiveness of DAAs for the treatment of HCV globally. The tool utilizes a mathematical model to simulate the life course of HCV-infected populations in 28 countries (considered as priority countries by the World Health Organization). The natural history of HCV calculated using this model has been validated with the results of a multicenter follow-up study of patients with advanced fibrosis.
An input panel (on the left side) of the Hep C Calculator allows users to select a country, local price of DAAs and laboratory tests, annual cost of management of various HCV disease stages (health states), and patient characteristics. For each set of selected values, the outcomes of two strategies – treatment with DAAs versus no treatment – are compared. The user can thus evaluate in real-time the following outcomes for each strategy: total costs (including the cost of HCV treatment and of downstream events such as the development of cirrhosis), quality-adjusted life-years (QALYs), and the cumulative incidences of decompensated cirrhosis, liver cancer, and HCV-related deaths. The model uses the health sector perspective, and calculates the incremental cost-effectiveness ratio (ICER) to determine whether treatment with DAAs produces cost-effective or cost-saving results. Read More...
Hepatitis C Testing Calculator is an interactive tool designed to evaluate the cost-effectiveness of different testing pathways for hepatitis C. The tool uses a mathematical model to simulate HCV disease progression. Users can input custom testing pathways and the cost-effectiveness of each pathway is calculated. This allows users to determine which testing strategies would be appropriate in various localized settings, as hepatitis C prevalence can vary substantially by jurisdiction, and differences in population characteristics and resources create different opportunities for testing and engaging patients in care.
The country can be changed in the tool, which changes the underlying disease burden model. Users can then change the cohort size, HCV prevalence, target screening rate, and treatment cost. An interactive interface allows users to create custom testing pathways, which can include up to 7 different stages: screening, confirmation, liver staging 1, liver staging 2, genotyping, monitoring, and SVR12. The type of test used, cost of the test, testing location (on-site or off-site), and patient follow-up rate for each stage in the screening pathway can be changed. The total costs and outcomes associated with each testing strategy (over a 30-year period) are displayed, and a preferred testing pathway is recommended based on a cost-effectiveness threshold.