David Kim

Cost Effectiveness of Implementing a Screening and Treatment Program for Hepatitis C Virus Infection in Egypt

AUTHORS: DD Kim, DW Hutton, AA Raouf, M Salama, A Hablas, IA Seifeldin, AS Soliman

Egypt has one of the highest prevalence of hepatitis C virus (HCV) infection in the World. We estimated the cost-effectiveness of implementing a screening and treatment program for HCV infection among Egyptians.

We developed a Markov decision analysis model of the natural history of HCV infection and treatment to evaluate the cost-effectiveness of a screening and treatment program for asymptomatic, average-risk Egyptian adults. We used hepatitis C age-specific disease progression rates and prevalence for Egyptians. Lifetime costs related to screening, treatment, disease progression and health utilities have been used with 3% annual discounting. We used a societal perspective, local cost estimates in Egypt, quality-adjusted life years (QALYs) gained, and calculated the incremental cost-effectiveness ratio of a hypothetical program of screening and treating Egyptians for HCV versus no screening. Sensitivity analysis was conducted to test uncertainty in the model assumptions.

Under base case assumptions, implementing a screening and treatment program for a 40-year-old, asymptomatic Egyptian adult would cost $1,856 for 19.192 QALYs, while non-screening would cost $1,807 for 19.164 QALYs for the 40 year time horizon. The incremental cost-effectiveness ratio (ICER) is $1,750/QALY (equivalent to about 10,392 LE, Egyptian pound/QALY). If applied to the entire population of 10 to 60 year-olds in Egypt, this program would lead to long-term costs of 2.15 billion dollars, but would save one million life years. Results were the most sensitive to change in disutility by being identified as HCV-positive after screening, as well as probability of receiving treatment after HCV positive diagnosis and probability of successful treatment.

Comparing this model to international standards for cost-effectiveness, implementing a screening and treatment program for HCV in Egypt would be considered very cost-effective. Therefore, we recommend implementing HCV screening and treatment programs to reduce the burden of liver disease in Egypt.


About David
David is originally from South Korea, and came to the United States for his undergraduate study at University of Michigan. He majored in Biomedical Engineering, and graduated in 2009 . After graduation, he worked as a research assistant at University of Michigan Comprehensive Cancer Center. David graduated from University of Michigan School of Public Health in May 2012 with a MS in Biostatistics.