OBJECTIVES: Disease burden due to chronic hepatitis C virus(HCV) infection is expected to increase in the coming decades in countries without comprehensive national treatment strategies with direct acting antivirals(DAA). Severe clinical sequalae of HCV, which includes end stage liver disease and liver cancer, will cause substantial financial implication. This study aims to estimate the healthcare cost of managing HCV at a tertiary-care referral centre in Malaysia, as an example of a middle-income country that has not yet adopted DAA drugs as standard HCV treatment.

METHODS: A costing analysis was conducted from the healthcare provider perspective. Annual resource use of standard interferon-based HCV treatment pathways was obtained by face-to-face interviews of local clinical experts(n=4). Unit costs specific to the referral centre(price year 2014) were derived by combining top down and bottom up activity-based costing methods. Costs were reported in US dollars(USD).

RESULTS: Estimated first year costs of managing non-cirrhotic chronic infection(NCCI), compensated cirrhosis(CC), decompensated cirrhosis(DC) and hepatocellular carcinoma(HCC) were USD7080, USD7295, USD7503 and USD7713 respectively which include interferon cost for NCCI and CC. Costs for subsequent years for NCCI and CC were USD243 and USD410 while costs for DC and HCC remain the same annually. Cost drivers for NCCI and CC was the cost of interferon(73% and 70%) in the first year, for DC was symptomatic clinical management of liver disease(47%) and for HCC was clinical management of cancer(33%).

CONCLUSIONS: The estimated annual healthcare costs increased corresponding to the severity of HCV-related liver disease. Current interferon-based treatment may lead to substantial downstream implications due to the low clinical effectiveness and limited patient eligibility for treatment. Adoption of DAA as standard treatment may require substantial upfront investment but it can potentially reduce HCV-related clinical morbidity and mortality and lower the national clinical and economic burden of HCV infection.