Modeling the efficiency of chronic hepatitis С treatment

Objective: To explore approaches to improving medical care for patients with chronic hepatitis С (CHC) at the national level.

Material and methods. A Markov model was used to predict the direct medical costs and outcomes (e.g., number of cured and died patients, cases of complications) for the treatment of CHC for 6 years in 300,000 patients. Two modeling scenarios were considered: a basic scenario included therapy administered with drugs in accordance with clinical guidelines and the standard of medical care for CHC patients; an alternative scenario focused on therapy with pan-genotypic drugs only.

Results. In the basic scenario, 298,034 people, or 99.3% of the cohort are treated over a period of 6 years. During this time, the disease develops into 236 cases of decompensated liver cirrhosis, 2,073 cases of hepatocellular carcinoma, 62 liver transplants required, and 430 deaths from complications of progressive liver decompensation. Total direct medical costs for this period are estimated at 105.3 billion rubles. Annual costs range from 16.5 billion rubles in the first year to 18.2 billion rubles in the sixth year. In the alternative scenario, a slight improvement in clinical outcomes is observed; however, the treatment cost increases from 105.8 billion rubles to 114.5 billion rubles (+8.7 billion rubles). It was found that decrease in the cost of drugs by 10%, 20%, 30%, or 40% can provide additional treatment for 31,706, 70,907, 120,615, and 185,707 patients, respectively.

Conclusion. The study made possible to assess the efficiency of the proposed measures for treating patients with CHC over a 6-year horizon, as well as the financial requirements for their implementation. Furthermore, possible measures to improve the effectiveness of CHC control activities and prospective ways to realize the benefits that could be achieved by reducing the cost of drug therapy were considered.

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