Background� The prevalence of HCV infection in Egypt is the highest in the

world (1): � Anti-HCV seroprevalence among individuals aged 15-59 years

estimated at 14.7% in 2008 (2).� Total economic burden of disease (direct health costs and indirect

costs due to lost productivity has not been previously studied). � With the introduction of more effective therapies, improved

understanding of economic costs can help inform policymakers to allow better allocation of resources to reduce HCV disease and cost burden.

Methodology

� Use a modeling approach to quantify 2013 costs associated with chronic HCV infection in Egypt, including indirect costs related to lost productivity.

Total Economic Burden of Hepatitis C in EgyptWaked I 1, Estes C 1, Abdel Razek W, 1 Zaghla H 1, Osman W 1, Abdel Kareem M,

1 Abdelsamea E 1, Mehrez M 1, Gomaa A, 1 Razavi H 2

1 National Liver Institute, Menoufiya, Egypt, 2 Center for Disease Analysis (CDA), Louisville, CO, USA

� A disease progression model was utilized to quantify disease and cost burden (3).� Data for prevalence by age and gender, genotype, incidence,

diagnosis, liver transplants and mortality risk factors were derived from Egyptian data sources (4-12) (Table).� To calculate the direct costs of healthcare: � Estimated the number of HCV infected population in each state

of the disease, including the number diagnosed and seeking medical care. � Costs calculated for each disease state from a nationally

representative government hospital.� Indirect costs estimated using WHO disability-adjusted life year

(DALY) template (13). � Years lost due to disability (YLD) from diagnosed chronic

hepatitis (F0-F3), compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma (HCC) and extrahepatic manifestations (diabetes and non-Hodgkins lymphoma). � Years of life lost (YLL) due to decompensated cirrhosis, HCC,

and extrahepatic manifestations (non-Hodgkins lymphoma) � Monetary value of a life year lost ($6,210 USD) was used to

calculate total indirect costs in 2013.

� This is the first estimate of the total economic burden of HCV in Egypt. � HCV forms a substantial economic burden in terms of both direct

and indirect costs. � Curbing the growth in disease burden is both a health and

economic necessity.

� An estimated 5,979,780 million individuals were chronically infected in 2013: � 5,196,410 had chronic hepatitis without cirrhosis (F0-F3) � 628,880 compensated cirrhosis (F4) � 137,280 decompensated cirrhosis � 16,070 HCC � 5,500 incremental cases of NHL attributable to HCV � 579,440 incremental cases of diabetes attributable to HCV. � HCV causes 29,170 deaths due to decompensated cirrhosis and

HCC, accounting for 222,330 YLLs (Figure 1a). � HCV is responsible for 201,040 YLDs and a total of 423,370 DALYs,

equivalent to $2,575 M (2013 USD) in indirect economic costs (Figure 1b). � Total direct healthcare cost amounted to $561 M (2013 USD)

accounting for 3.7% of the total health expenditure. � The total economic burden of HCV in Egypt in 2013 is estimated at 3.1

Billion (2013 USD), or 1.4% of Egypt’s total gross domestic product (GDP).

Objective

Methods

Background

References

Conclusion

Disclosures

Table: Historical Egypt model inputs and 2013 estimates

Figure 1a. DALYs by disease stage – Egypt, 2013-

Results

C. Estes and H. Razavi are employees of the Center for Disease Analysis (CDA);

I. Waked: Speaker: Roche, Merck, BMS, GSK, Bayer, Gilead, Minapharm, Advisory Board: Janssen, Roche, Merck, Novartis, GSK, Minapharm, Evapharm. Investigator in clinical trials: Roche, BMS, GSK, Bayer;

W. Abdel Razek, H Zaghla, W Osman, M Abdel Kareem, E Abdelsamea, M Mehrez, A Gomaa: Nothing to disclose.

(1) Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect 2011 Feb;17(2):107-15.

(2) El-Zanaty F, Way A. Egypt demographic and health survey, 2008. 431. 2009. Cairo, Cairo, Egypt : Ministry of Health and Population, 2009. Demographic and Health Survey (EDHS).

(3) Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat 2014 May;21 Suppl 1:34-59.

(4) Central Agency for Public Mobilization and Statistics, CAPMAS. Estimates of Midyear Population by Age Groups (2006-2012). 11-21-2013. 11-21-2013.

(5) Abdel-Hamid M, El-Daly M, Molnegren V, El-Kafrawy S, Abdel-Latif S, Esmat G, et al. Genetic diversity in hepatitis C virus in Egypt and possible association with hepatocellular carcinoma. J Gen Virol 2007 May;88(Pt 5):1526-31.

(6) Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology 2008 Aug;48(2):418-31.

(7) Personal Communication. Data from National Liver Institute. 8-26-2013. 8-26-2013. (8) Breban R, Doss W, Esmat G, Elsayed M, Hellard M, Ayscue P, et al. Towards realistic estimates of

HCV incidence in Egypt. J Viral Hepat 2013 Apr;20(4):294-6. (9) Miller FD, Abu-Raddad LJ. Evidence of intense ongoing endemic transmission of hepatitis C virus

in Egypt. Proc Natl Acad Sci U S A 2010 Aug 17;107(33):14757-62. (10) World Health Organization. Global Health Observatory. 11-21-2013. 11-21-2013. (11) UNAIDS: Joint United Nations Programme on HIV/AIDS. Middle East and North Africa: Regional

Report on AIDS 2011. 2011. (12) Elhawary EI, Mahmoud GF, El-Daly MA, Mekky FA, Esmat GG, Abdel-Hamid M. Association of

HCV with diabetes mellitus: an Egyptian case-control study. Virol J 2011;8:367. (13) World Health Organization. Disability adjusted life years (DALY). 2014.

Figure 1b. Costs by disease stage – Egypt, 2013

Historical Year 2013 (Est.)

HCV Infected Cases 9,387,390 (8,448,650 - 10,326,130) 2008 8,830,770

Anti-HCV Prevalence 12.5% (11.2% - 13.7%) 10.70%

Total Viremic Cases 6,358,190 (5,722,370 - 6,994,000) 2008 5,981,180

Viremic Prevalence 8.5% (7.6% - 9.3%) 7.20%

Viremic Rate 67.70% 67.70%

HCV Diagnosed (Viremic) 713,020 2010 858,530

11.20% 14.40%

Annual Newly Diagnosed 125,000 2010 125,000

New Infections 168,620

204

Treated

Number Treated 65,000 2011 62,700

Annual Treatment Rate 1.00% 1.00%

Risk Factors

9,970

% Active IDU 0.17%

1,453,430

24.30%

Diabetes 9.70%

% Diabetes 579,580

Viremic Diagnosis Rate

New Infection Rate (per 100K)

Number of Active IDU with HCV

Previous Blood Transfusion

% Previous Blood Transfusion

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

2013 indirect costs 2013 direct costs

Cos

ts –

2013

USD

(M)

Extrahepatic (diabetes and non-Hodgkins lymphoma)

HCC

Decomp. Cirrhosis

Comp. Cirrhosis

Chronic Hepatitis (F0-F3)

Direct Healthcare Costs

0

50,000

100,000

150,000

200,000

250,000

2013 YLDs by disease stage

2013 YLLs by disease stage

DA

LYs

Extrahepatic (diabetes and non-Hodgkins lymphoma)

HCC

Decomp. Cirrhosis

Comp. Cirrhosis

Chronic Hepatitis (F0-F3)