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Cost-effectiveness of scaling up of hepatitis C screening and treatment: a modelling study in South Korea
  1. Jungyeon Kim1,
  2. Markus Haacker1,2,
  3. Salmaan Keshavjee3,
  4. Rifat Atun1,4
  1. 1Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
  2. 2Centre for Global Health Economics, University College London, London, UK
  3. 3Center for Global Health Delivery - Dubai, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
  4. 4Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
  1. Correspondence to Dr Rifat Atun; ratun{at}hsph.harvard.edu

Abstract

Background The prices and the coverage of effective direct-acting antivirals (DAAs) to treat hepatitis C vary across countries. South Korea expanded DAAs coverage through national health insurance. This study aims to analyse the cost-effectiveness of scale-up of hepatitis C screening and treatment with DAAs in South Korea, a high-income country.

Methods This study uses a compartmental age–sex structured model of progression of hepatitis C to analyse effects of different policy choices for the scale up of screening and treatment with DAAs on hepatitis C disease burden and costs from 2017 to 2050. Policy scenarios considered in our study are (1) no treatment, (2) status quo, (3) screening population aged over 60 years, (4) screening population over 40 years and (5) screening population aged over 20 years.

Results The continuation of current policy with the expansion of DAAs coverage is estimated to reduce the prevalence of hepatitis C antibody from 0.6% in 2015 to 0.25% in 2050 of the adult population. Status quo policy, screening from age 60, screening from age 40 and screening from age 20 are cost-effective in terms of averted infection at estimated incremental cost-effective ratio of US$101 208, US$111 770, US$107 909 and US$229 604.

Conclusions The expansion of DAAs coverage by the national health insurance is highly effective in alleviating hepatitis C disease burden. The scale-up of screening and treatment with DAAs for targeted adult population with high prevalence of hepatitis C is cost-effective. This study provides a case for policy-makers to invest in rapid expansion of hepatitis C comprehensive screening and treatment with DAAs.

  • viral hepatitis
  • health insurance
  • screening
  • treatment
  • health economics

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2019-001441

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors RA conceived the original idea. JK designed the study, collected the data, analysed and interpreted the data and wrote the manuscript with input from all authors. MH constructed the model, analysed and interpreted the data. RA and SK supervised the project and contributed to the interpretation of the results. All authors provided critical feedback and contributed to the final version of the manuscript.

    • Funding This work was supported by Harvard Medical School Center for Global Health Delivery-Dubai.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open-access repository.