Purpose: The public health burden of hepatitis C virus (HCV) infection is considerable. We evaluated the current and future burden of HCV in Australia from a societal perspective over the period 2010-2039.
Method: A dynamic mathematical transmission model was developed to simulate HCV transmission among injecting drug users (IDUs) and non-IDUs and to track the natural history of disease progression of infected people. Healthcare costs for hepatitis C were estimated from activity-based analysis and national databases. Patient/family time costs were estimated based on Canadian estimates. Productivity losses were estimated using the friction cost method. All costs were adjusted to 2008 Australian dollars. A cost-effectiveness and cost-utility analysis was performed to compare the costs and benefits associated with five alternative HCV treatment scenarios.
Result: Under current levels of treatment, where ~3,500 HCV cases are treated each year, it was estimated that there would be ~11,700 new HCV infections in Australia in 2010, which would remain relatively stable over the next 30-year period. Our model estimated 228 new cases of liver failure, 121 new cases of liver cancer, 44 liver transplant cases and 241 liver-related deaths, and 4,759 potential years of life lost in 2010. These numbers would increase by 11-13% in 2039 under current conditions. We estimated that there would be $1.1 billion cost of HCV in 2010; of which, 17% would be attributed to healthcare costs, 44% to patient/family time costs, and 39% to productivity costs. HCV-related chronic liver disease contributes ~90% of the costs, and HCV-related liver failure, liver cancer and liver transplant contributes the remaining 10%. The total costs would increase by 75% in 2039 under current conditions. If treatment rates are increased by 250% (to ~12,000 per year), the number of new cases of liver failure, liver cancer, and the number of liver transplant cases and liver-related deaths are expected to decrease by ~20%, with substantial long-term total cost savings ($274m, 5% discount) and gains in life years (20,353) and quality-adjusted life years (QALYs) (80,614) (undiscounted). Incremental cost-effectiveness ratios ranged between $16,000-$17,000/QALY, and were most sensitive to assumptions about drug costs, utilities for early disease stage, and discount rate.
Conclusion: Strategies to improve treatment uptake is critical in order to mitigate the future burden of hepatitis C and our results help inform policy decision-making.