RESUMO
BACKGROUND & AIMS: Egypt used to have one of the highest prevalences of HCV infection worldwide. The Egyptian Ministry of Health launched a national campaign for the detection and management of HCV to reduce its burden. This study aims to carry out a cost-effectiveness analysis to evaluate the costs and benefits of the Egyptian national screening and treatment programme. METHODS: A disease burden and economic impact model was populated with the Egyptian national screening and treatment programme data to assess direct medical costs, health effects measured in disability-adjusted life years and the incremental cost-effectiveness ratio. The scenario was compared to a historical base case, which assumed that no programme had been conducted. RESULTS: Total number of viremic cases is expected to decrease in 2030 by 86% under the national screening and treatment programme, versus by 41% under the historical base case. Annual discounted direct medical costs are expected to decrease from $178 million in 2018 to $81 million by 2030 under the historical base case, while annual direct medical costs are estimated to have peaked in 2019 at $312 million before declining to $55 million by 2030 under the national screening and treatment programme. Under the programme, annual disability-adjusted life years are expected to decline to 127 647 by 2030, leading to 883 333 cumulative disability-adjusted life years averted over 2018-2030. CONCLUSIONS: The national screening and treatment programme is highly cost-effective by the year 2021, cost-saving by 2029 and expected to save about $35 million in direct costs and $4705 million in indirect costs by 2030.
Assuntos
Hepatite C , Humanos , Análise Custo-Benefício , Egito/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Análise de Custo-EfetividadeAssuntos
Antivirais/uso terapêutico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Imidazóis/uso terapêutico , Programas de Rastreamento , Adolescente , Adulto , Antivirais/economia , Carbamatos , Egito/epidemiologia , Feminino , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/prevenção & controle , Humanos , Imidazóis/economia , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Pirrolidinas , Estudos Soroepidemiológicos , Sofosbuvir/economia , Sofosbuvir/uso terapêutico , Valina/análogos & derivados , Adulto JovemRESUMO
The utility, efficacy and cost-effectiveness of establishing a prospective screening program for hepatocellular carcinoma (HCC) in a low-cost setting as Egypt has not been previously studied. Eligible patients in this observational study were screened by ultrasound and alpha-fetoprotein (AFP) every 6 months. A focal lesion on ultrasound or AFP >200 ng/ml or significant increase in 6 months indicated a recall. Characteristics of cases detected on screening were compared to patients diagnosed outside the screening program. Of 1,920 eligible patients, 1,286 patients participated and 102 patients (7.9 %) developed HCC, with an annual incidence of 5.3 %. Ninety-one (89.2 %) were BCLC stage 0 or A and 11 (10.8 %) stage D. Ultrasound detected a hepatic focal lesion in 99 patients, of which 74 were confirmed to be HCC, and AFP added another 28 HCC cases. The annual cost of detecting a treatable HCC case by ultrasound was 3,980 EGP (