Kim Jungyeon, Haacker Markus, Keshavjee Salmaan, Atun Rifat
Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Centre for Global Health Economics, University College London, London, UK.
BMJ Glob Health. 2019 Jun 4;4(3):e001441. doi: 10.1136/bmjgh-2019-001441. eCollection 2019.
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.
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.
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.
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.
治疗丙型肝炎的有效直接抗病毒药物（DAA）的价格和覆盖范围在各国有所不同。韩国通过国家医疗保险扩大了DAA的覆盖范围。本研究旨在分析在高收入国家韩国扩大丙型肝炎筛查和使用DAA治疗的成本效益。
本研究使用丙型肝炎进展的年龄-性别分层模型，分析2017年至2050年不同扩大DAA筛查和治疗政策选择对丙型肝炎疾病负担和成本的影响。我们研究中考虑的政策情景包括：（1）不治疗；（2）现状；（3）筛查60岁以上人群；（4）筛查40岁以上人群；（5）筛查20岁以上人群。
估计随着DAA覆盖范围的扩大，继续实施现行政策可使丙型肝炎抗体在成年人群中的患病率从2015年的0.6%降至2050年的0.25%。现状政策、从60岁开始筛查、从40岁开始筛查和从20岁开始筛查在避免感染方面具有成本效益，估计增量成本效益比分别为101208美元、111770美元、107909美元和229604美元。
国家医疗保险扩大DAA覆盖范围在减轻丙型肝炎疾病负担方面非常有效。针对丙型肝炎高流行的目标成年人群扩大DAA筛查和治疗具有成本效益。本研究为政策制定者投资快速扩大丙型肝炎DAA综合筛查和治疗提供了案例。
