OBJECTIVES: Hepatitis C virus (HCV) is a global public health crisis impacting 71 million infected patients. Egypt presents the highest HCV global prevalence. Despite evidence of positive effects of HCV testing/screening, adoption globally remains limited. Recently, the Egyptian Ministry of Health implemented three different HCV screening/testing/therapy programs: In 2014 (wave 1), major decisions on HCV therapy were enacted, accompanied by a 99% discount for the HCV-therapy Sovaldi. In 2016 (wave 2), a first testing program was launched to identify patients for free treatment. In 2018 (wave 3), population-wide screening was conducted using a WHO-qualified test (SD Bioline HCV, Abbott, USA) to identify/treat all Egyptians with HCV. We estimated the financial advantages of HCV screening programs (wave 1-3 results) vs a baseline period of limited Egyptian HCV testing/therapeutic intervention (2008-2014).

METHODS: Using published evidence, the direct costs of the different HCV programs were evaluated, accompanied by a conservative simulation of major HCV health consequences (i.e., liver-related deaths/life years lost) and related indirect costs. Total economic consequences of each HCV program were compared to each other and baseline from a societal perspective. Future costs and health effects were discounted by 3% per year.

RESULTS: Discounted total costs (in USD) were: $1,096M (baseline); $949M (wave 1); $467M (wave 2); and $404M (wave 3). Discounted HCV-related life years lost were: 444.427 (baseline); 403.191 (wave 1); 152.017 (wave 2); and 65.921 (wave 3). With each successive Egyptian HCV screening/testing/therapy wave, total costs and HCV-related mortality were reduced. Wave 3, using the WHO-qualified test, was most cost effective of the three waves.

CONCLUSIONS: Country-wide HCV elimination programs can improve health outcomes and reduce economic HCV burden from a societal perspective. Use of the WHO-qualified test was the most dominant approach to cost effectiveness. These results provide rationale for worldwide scalability of similar HCV elimination programs.