Projections of the healthcare costs and disease burden due to hepatitis C infection under different treatment policies in Malaysia, 2018-2040

Scott A. McDonald, Amirah Azzeri, Fatiha Hana Shabaruddin, Maznah Dahlui, Soek S. Tan, Adeeba Kamarulzaman, Rosmawati Mohamed

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Objective. As recommended for subscribers to the WHO Global Health Sector Strategy on viral hepatitis, and to inform the development of a national strategic plan for Malaysia, we estimated the long-term burden incurred by the care and management of patients with hepatitis C virus (HCV) infection. We compared cumulative healthcare costs and disease burden under different treatment cascade scenarios.
Methods. We attached direct costs for management/care of chronically HCV-infected patients to a previously developed clinical disease progression model. Under assumptions regarding: disease stage-specific proportions of model-predicted HCV patients within care, annual numbers of patients initiated on antiviral treatment, and distribution of treatments over stage, we projected the healthcare costs and disease burden (in DALY) in 2018-2040 under four treatment scenarios: (a) no treatment/baseline; (b) pre-2018 standard of care (pegylated interferon/ribavirin); (c) gradual scale-up in direct-acting antiviral (DAA) treatment uptake that does not meet the WHO 2030 treatment uptake target; (d) scale-up in DAA treatment uptake that meets the WHO 2030 target.
Results. Scenario (d), while achieving the WHO 2030 target and averting 253,500 DALYs compared with the pre-2018 standard of care (b), incurred the highest direct patient costs over the period 2018-2030, of US$890 million (95% uncertainty interval: 653–1,271 million). When including screening programme costs, the total cost was estimated at US$952 million, which was 12% higher than the estimated total cost of Scenario (c).
Conclusions. The scale-up to meet the WHO 2030 target may be achievable with appropriately high governmental commitment for the expansion of HCV screening to bring sufficient undiagnosed chronically-infected persons into the treatment pathway.
Key Points for Decision-makers
•WHO initiatives to greatly reduce the burden of HCV by 2030 have led many – mostly well-resourced – countries to update national treatment policies to include the new and highly effective DAA therapies.
•For the first time, we make available projections of the direct healthcare costs of HCV management under different treatment scenarios for Malaysia.
•An enormous scale-up in screening activity and treatment uptake is needed to meet the WHO 2030 targets; due to savings in care costs this scale-up is only moderately more expensive than a less steep scale-up strategy.
Original languageEnglish
Pages (from-to)847-857
Number of pages11
JournalApplied Health Economics and Health Policy
Issue number6
Early online date25 Aug 2018
Publication statusPublished - Dec 2018


  • hepatitis C infection
  • healthcare costs
  • WHO

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