Return on investment in needle and syringe programs in Australia: report

4.5 Methodology for health care costings for HCV infection

Page last updated: 2002

The following assumptions were employed in determination of health care costs for hepatitis C:

  • 75% of people who acquire HCV infection develop chronic hepatitis C.

  • The health care costs of acute hepatitis C are small, due to the largely asymptomatic nature of newly acquired HCV infection, and therefore were not considered in the total costs.

  • All people with chronic hepatitis C are at risk of progression to advanced liver disease complications.

  • People can either remain in disease states or progress forward but not regress.

4.5.1 Treatment protocols and costs for HCV

Table 4.5.1 outlines treatment protocols for HCV and their cost estimates. Additional health care service items for stages 1-3, but for total period rather than per year are:
  • Liver ultrasound x 2
  • Liver biopsy x 2
  • Pathology services (HIV serology x 1, HBV serology x 1, Iron studies x 1, full blood count x 4, alpha-1-antytrypsin level x 1, caeruloplasmin level x 1, ANA/auto-antibodies x 1, HCV genotype x 1, HCV viral load x 1)
These costs have been estimated at $2,358 per case (Year 2000 prices)

Hospitalisation is assumed to only be required for:
  • Liver biopsy (day only stay)
  • Liver failure (incorporated into total cost estimate)
  • Hepatocellular carcinoma (incorporated into total cost estimate)
Of the estimated 150,000 people living with chronic hepatitis C in Australia (Law 1999), less than 10% will have received combination therapy, the preferred treatment for hepatitis C, consisting of interferon and ribavirin. For this reason, and the assumption that the costs of combination therapy will have been balanced by some reduction in development of advanced liver disease complications, we have not costed combination therapy in the analysis.
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Table 4.5.1 Treatment protocols and their costs for HCV disease

Table 4.5.1 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Disease stages and costs of health care services:
  1. Mild chronic hepatitis C1

    • Doctor visits (specialist x 1, primary care x 2) - $164
    • Pathology services (liver function tests x 2) - $39

  2. Moderate chronic hepatitis C1

    • Doctor visits (specialist x 1, primary care x 2) - $164
    • Pathology services (liver function tests x 2) - $39

  3. Compensated cirrhosis1

    • Doctor visits (specialist x 2, primary care x 2) - $198
    • Pathology services (liver function tests x 2, full blood count x 1, alpha-fetoprotein x 1, liver ultrasound x 1) - $182

  4. Liver failure2

    • Without transplant (80% of patients), cost per patient - $164,340
    • With transplant (20% of patients), cost of transplant - $75,000
    • Expected cost per episode - $146,472

  5. Hepatocellular carcinoma2

    • Without surgery (76% of patients), cost per patient - $117,895
    • With surgery (33% of patients), cost per patient - $28,290
    • Expected cost per episode - $88,325

1 Health care services are per year per case in disease stage, based on CMBS Schedule Fee (2000).
2 Cost estimates are previous Australian figures from Shiell et al (1994), without adjustment for inflation.

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