Health  Vol.9 No.11 , October 2017
Managing Hepatitis C Patients in Greece: A Budget Impact Analysis of Simeprevir plus Pegylated Interferon/Ribavirin Regimen at Early Stages of the Disease
Abstract: Objectives: To identify local resource use such as pharmaceutical treatment, medical follow-up, and patient hospitalization and estimate the budget impact of simeprevir (SMV) plus pegylated interferon (P)/ribavirin (R) as a treatment option in the early stages of the disease in Greece. Methods: A budget impact tool was developed with a two-year time horizon, which estimated the impact on the Social Insurance Funds (SIFs) of introducing SMV + PR in the management of the early disease stages. Total direct and indirect costs were estimated for each of the following health states: non-cirrhotic chronic Hepatitis C (and within that by fibrosis stage), compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma. Data gaps on treatment algorithms, resource use and productivity losses were covered via an expert panel of eight leading hepatologists. Epidemiology data were taken from the published literature. Unit costs were obtained from the Ministry of Health and SIFs. The perspective was that of the SIF and the cost base year was 2015. Results: The total (direct and indirect) cost per patient per year (excluding cost of antiviral treatment) was estimated at €647, €703, €5,753, €16,313 and €37,237 for non-cirrhotic CHC, compensated cirrhosis, decompensated cirrhosis, HCC and liver transplantation, respectively. The budget impact analysis showed that adding SMV to PR in the early stages of the disease would lead to an increase in the cost of antiviral treatment by €2.03 million. Conclusions: Costs of managing CHC increase dramatically with disease severity. SMV + PR for naive patients at early disease stages has a significant but manageable budget impact, and could prevent high costs in advanced stages.
Cite this paper: Geitona, M. , Kousoulakou, H. , Goulis, I. , Manolakopoulos, S. , Vasiliadis, T. , Christodoulou, D. , Gogos, C. , Dourakis, S. , George Koskinas, I. , Papadokostopoulou, A. , Lathouris, A. and Papatheodoridis, G. (2017) Managing Hepatitis C Patients in Greece: A Budget Impact Analysis of Simeprevir plus Pegylated Interferon/Ribavirin Regimen at Early Stages of the Disease. Health, 9, 1482-1493. doi: 10.4236/health.2017.911109.

[1]   Mühlberger, N., Schwarzer, R., Lettmeier, B., Sroczynski, G., Zeuzem, S. and Siebert, U. (2009) HCV-Related Burden of Disease in Europe: A Systematic Assessment of Incidence, Prevalence, Morbidity, and Mortality. BMC Public Health, 9, 34.

[2]   Zanetti, A.R. (1999) Global Surveillance and Control of Hepatitis C. Report of a WHO Consultation Organized in Collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. Journal of Viral Hepatitis, 6, 35-47.

[3]   European Association on the Studies on the Liver (EASL) (1999) EASL International Consensus Conference on Hepatitis C. Paris, 26-27 February 1999, Consensus Statement. Journal of Hepatology, 31(Suppl. 1), 3-8.

[4]   Lauer, G.M. and Walker, B.D. (2001) Hepatitis C Virus Infection. The New England Journal of Medicine, 345, 41-52.

[5]   Alter, H.J. and Seeff, L.B. (2000) Recovery, Persistence, and Sequelae in Hepatitis C Virus Infection: A Perspective on Long-Term Outcome. Seminars in Liver Disease, 20, 0017-0036.

[6]   Raptopoulou, M., Touloumi, G., Tzourmakliotis, D., Nikolopoulou, G., Dimopoulou, M., Giannoulis, G. and Manolakopoulos, S. (2011) Significant Epidemiological Changes in Chronic Hepatitis C Infection: Results of the Nationwide HEPNET-GREECE Cohort Study. Hippokratia, 15, 26-31.

[7]   Gogos, C.A., Fouka, K.P., Nikiforidis, G., Avgeridis, K., Sakellaropoulos, G., Bassaris, H. and Skoutelis, A. (2003) Prevalence of Hepatitis B and C Virus Infection in the General Population and Selected Groups in South-Western Greece. European Journal of Epidemiology, 18, 551-557.

[8]   Goritsas, C., Plerou, I., Agaliotis, S., Spinthaki, R., Mimidis, K., Velissaris, D. and Labropoulou-Karatza, C. (1999) HCV Infection in the General Population of a Greek Island: Prevalence and Risk Factors. Hepato-Gastroenterology, 47, 782-785.

[9]   Koulentaki, M., Spanoudakis, S., Kantidaki, E., Drandakis, P., Tzagarakis, N., Biziagos, E. and Kouroumalis, E.A. (1999) Prevalence of Hepatitis B and C Markers in Volunteer Blood Donors in Crete. A 5-year Study. Journal of Viral Hepatitis, 6, 243-248.

[10]   Malliori, M., Sypsa, V., Psichogiou, M., Touloumi, G., Skoutelis, A., Tassopoulos, N. and Stefanis, C. (1998) A Survey of Bloodborne Viruses and Associated Risk Behaviours in Greek Prisons. Addiction, 93, 243-251.

[11]   Hatzakis, A., Chulanov, V., Gadano, A.C., Bergin, C., Ben-Ari, Z., Mossong, J., Schréter, I., Baatarkhuu, O., Acharya, S., Aho, I., Anand, A.C., Andersson, M.I., Arendt, V., Arkkila, P., Barclay, K., Bessone, F., Blach, S., Blokhina, N., Brunton, C.R., Choudhuri, G., Cisneros, L., Croes, E.A., Dahgwahdorj, Y.A., Dalgard, O., Daruich, J.R., Dashdorj, N.R., Davaadorj, D., de Knegt, R.J., de Vree, M., Estes, C., et al. (2015) The Present and Future Disease Burden of Hepatitis C Virus (HCV) Infections with Today’s Treatment Paradigm Volume 2. Journal of Viral Hepatitis, 22, 26-45.

[12]   Giannousis, I.P., Papatheodoridis, G.V., Deutsch, M.J., Manolakopoulos, S.G., Manesis, E.K., Koskinas, J.S. and Archimandritis, A.J. (2010) The Burden and Recent Epidemiological Changes of the Main Chronic Liver Diseases in a Greek Referral Tertiary Centre. European Journal of Gastroenterology & Hepatology, 22, 172-179.

[13]   Younossi, Z.M., Singer, M.E., Mir, H.M., Henry, L. and Hunt, S. (2014) Impact of Interferon Free Regimens on Clinical and Cost Outcomes for Chronic Hepatitis C Genotype 1 Patients. Journal of Hepatology, 60, 530-537.

[14]   Wong, J.B., McQuillan, G.M., McHutchison, J.G. and Poynard, T. (2000) Estimating Future Hepatitis C Morbidity, Mortality, and Costs in the United States. American Journal of Public Health, 90, 1562.

[15]   Kowdley, K.V., Lawitz, E., Poordad, F., Cohen, D.E., Nelson, D.R., Zeuzem, S., Xie, W., et al. (2014) Phase 2b Trial of Interferon-Free Therapy for Hepatitis C Virus Genotype 1. New England Journal of Medicine, 370, 222-232.

[16]   Mohamed, A.A., Elbedewy, T.A., El-Serafy, M., El-Toukhy, N., Ahmed, W. and Ali El Din, Z. (2015) Hepatitis C Virus: A Global View. World Journal of Hepatology, 7, 2676-2680.

[17]   Hsu, C.C. and Sandford, B.A. (2007) The Delphi Technique: Making Sense of Consensus. Practical Assessment, Research & Evaluation, 12, 1-8.

[18]   Ministry of Health: Positive Reimbursement List. Governmental Gazette 333-16.2.16.

[19]   Ministry of Health.

[20]   National Organization for Health Care Services Provision.

[21]   Ministry of Health (2012) Diagnosis Related Groups and Related Tariffs. Governmental Gazette 946, 27/3/2012.

[22]   OECD: Data Extracted in Apr 2016 from OECD. Stat.

[23]   KEPA-IKA.


[25]   Papatheodoridis, G., Sypsa, V., Kantzanou, M., Nikolakopoulos, I. And Hatzakis, A. (2015) Estimating the Treatment Cascade of Chronic Hepatitis B and C in Greece using a Telephone Survey. Journal of Viral Hepatitis, 22, 409-415.

[26]   Manolakopoulos, S. (2013) Greek Final Outcomes of the Multicentered Study GUARD-C in Chronic Hepatitis C. Annals of Gastroenterology, 26, 45.

[27]   Athanasakis, K., Arzoumanidou, D., Petrakis, I., Karampli, E., Theodoropoulou, T., Retsa, M. and Kyriopoulos, J. (2013) A Cost-of-Illness Analysis of Hepatitis C in Greece. Value Heal, 16, A323-A636.

[28]   Athanasakis, K., Ferrante, S.A., Kyriopoulos, I.I., Petrakis, I., Hill, M., Retsa, M.P. and Kyriopoulos, J. (2015) Boceprevir for Chronic Genotype 1 Hepatitis C Virus in the Current Health Care Setting in Greece: A Cost-Effectiveness Analysis. Clinical Therapeutics, 37, 1529-1540.

[29]   Yfantopoulos, J., Papagiannopoulou, V., Kaligeros, K., Manolakopoulos, S., Charos, A. and Koskinas, J. (2008) Economic Evaluation of Hepatitis C in Greece. Arch Hell Med, 1, 191-200.

[30]   Solomon, M., Bonafede, M., Pan, K., Wilson, K., Beam, C., Chakravarti, P. and Spiegel, B. (2011) Direct Medical Care Costs among Pegylated Interferon plus Ribavirin-Treated and Untreated Chronic Hepatitis C Patients. Digestive Diseases and Sciences, 56, 3024-3031.

[31]   Westerhout, K., Treur, M., Mehnert, A., Pascoe, K., Ladha, I. And Belsey, J. (2015) A Cost Utility Analysis of Simeprevir Used with Peginterferon+ Ribavirin in the Management of Genotype 1 Hepatitis C Virus Infection, from the Perspective of the UK National Health Service. Journal of Medical Economics, 18, 838-849.

[32]   Global Burden of Hepatitis C Working Group (2004) Global Burden of Disease (GBD) for Hepatitis C. The Journal of Clinical Pharmacology, 44, 20-29.