Future burden of hepatitis C due to increased treatment

6. Estimating the burden of hepatitis C and consequences of increased treatment uptake

6.7 Future burden of hepatitis C due to increased treatment

Action in form of increased treatment can have a substantial effect on the future burden of hepatitis C.

In France, complications due to hepatitis C can be reduced to such an extent that the initial investment in treatment is completely offset by savings in health care costs and indirect costs making the intervention cost-saving. In Romania, higher treatment uptake combined with more effective drugs has the potential to reduce future burden substantially.

Unless action is taken, health care costs in Romania will double by 2040.

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

6.7.1 France

As described above, the prevalence of hepatitis C in France is projected to decrease under current treatment levels. However, the pace of this process is increased if treatment levels are increased and this would have a substantial effect on mortality, number of liver cancers and liver transplantations.

Figure 16 shows the evolution of annual deaths due to hepatitis C (top panel) and number of patients with HCC (low panel) under the three analysed scenarios;

i. Today’s treatment levels remain constant (blue line) until 2040 ii. Treatment levels are increased (red line) up until 2019

iii. Increased treatment levels (up until 2019) are combined with increased efficacy until 2040 (green line)

Figure 17 shows the corresponding evolution of number of patients undergoing a liver transplantation.

1 800 1 600 1 400 1 200 1 000 800 600 400 200 0

Baseline Increased treatment Increased treatment + efficacy

3 000 2 500 2 000 1 500 1 000 500

2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 Baseline Increased treatment Increased treatment + efficacy

Figure 16 Projected number of annual deaths and patients with HCC in France

By increasing treatment levels up until 2019, the increase in number of deaths otherwise observed under current treatment levels would initially decrease to around 1,100 deaths until 2033 when it

Annual number of patients living with HCCAnnual number of deaths due to hepatitis C 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

would decrease further. If increased treatment were combined with higher efficacy, annual deaths would be reduced continuously throughout the time horizon to reach around 350 deaths annually by 2040.

700 600 500 400 300 200 100 0

Baseline Increased treatment Increased treatment + efficacy

450 000 400 000 350 000 300 000 250 000 200 000 150 000 100 000 50 000 0

Baseline Increased treatment Increased treatment + efficacy

Figure 17 Projected annual number of liver transplantations and number of infected individuals in France

The number of liver transplantations is projected to initially increase in all three scenarios from today’s levels of around 300 liver transplantations annually. Under current treatment levels, the number of liver transplantations is expected to almost double by 2030. If treatment is increased, liver transplantations are expected to increase to 400 by 2030. If the increase in treatment is combined with

Higher treatment uptake in France has the potential to lower the number of annual deaths due to hepatitis C.

Higher treatment uptake has the potential to reduce the number of patients with HCC in 2040 by more than 60% compared to today’s levels.

Number of infected patientsAnnual number of liver transplantations 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

higher efficacy rates, the number of liver transplantations will start decreasing within a few years. By 2040, the number of liver transplantations will be reduced by almost 50% compared to current treatment levels.

6 000 5 000 4 000 3 000 2 000 1 000 0

Baseline Increased treatment Increased treatment + efficacy

18 000 16 000 14 000 12 000 10 000 8 000 6 000 4 000 2 000 0

Baseline Increased treatment Increased treatment + efficacy

Figure 18 Projected health care costs (top panel) and indirect cost (low panel) in France

Health care costs are expected to increase in France under current treatment levels despite the general decrease in prevalent cases. This is explained by the fact that the average hepatitis C patient will be in a more severe and therefore, more costly state. By increasing treatment uptake, however, the health care costs can be maintained close to today’s levels for the next 5 years when they start to decrease. By 2040, health care costs will be 30% lower compared to what they would be if treatment were maintained at current levels.

million €million € 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

600 000 500 000 400 000 300 000 200 000 100 000

Health care costs Drug costs Indirect costs Total cost Baseline Increased treatment Increased treatment + efficacy

Figure 19 Total accumulated costs between 2014 and 2040 in France¹⁰

Figure 19 shows the total accumulated costs over the entire time horizon. The increased treatment scenario reduces both health care costs and indirect costs and these two together offset the increase in drug costs. The total accumulated cost when increased treatment combined with higher efficacy is also included in the figure.

6.7.2 Romania

The general prevalence of hepatitis C is projected to decrease in Romania. Yet, the country faces an increasing burden of hepatitis C as cases of cirrhosis, decompensated cirrhosis and liver cancer are expected to increase. Figure 20 shows the evolution of annual deaths due to hepatitis C (top panel) and number of patients with HCC (low panel) under the three analysed scenarios;

i. Today’s treatment levels remain constant (blue line) until 2040 ii. Treatment levels are increased (red line) up until 2019

iii. Increased treatment levels (up until 2019) are combined with increased efficacy until 2040 (green line)

Figure 21 shows the corresponding evolution of number of patients with liver cancers and patients undergoing a liver transplantation.

10 Note that no extra cost of treatment has been assumed in the scenario in which increased treatment is combined with higher efficacy. Therefore, drug costs and total costs should be interpreted with caution.

Increasing treatment in France has the potential to reduce the health care costs of hepatitis C.

Under current treatment levels, health care costs are expected to increase by 32% within the next 10-12 years.

By combining higher treatment uptake with more effective treatment, health care costs are projected to decrease by more than 65% by 2040 compared to today’s levels.

Increasing treatment uptake with today’s standard of care is cost-saving in France.

million €

4 000 3 500 3 000 2 500 2 000 1 500 1 000 500 0

Baseline Increased treatment Increased treatment + efficacy

5 000 4 500 4 000 3 500 3 000 2 500 2 000 1 500 1 000 500 0

Baseline Increased treatment Increased treatment + efficacy

Figure 20 Projected number of annual deaths and patients with HCC in Romania

Increasing treatment with higher efficacy in Romania may reduce the number of annual deaths by 2040 due to hepatitis C by as much as 50%.

Increasing treatment with higher efficacy has the potential to maintain the number of people with liver cancer. Under current treatment levels, this number is expected to have doubled by 2040.

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

1 400 1 200 1 000 800 600 400 200 0

Baseline Increased treatment Increased treatment + efficacy

Figure 21 Projected annual number of liver transplantations in Romania

The number of liver transplantations (shown in Figure 21) is expected to increase. However, by increasing treatment and efficacy, this substantial increase can be curbed.

600 000 500 000 400 000 300 000 200 000 100 000 0

Baseline Increased treatment Increased treatment + efficacy

Figure 22 Projected number of infected individuals in Romania

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

3 000 2 500 2 000 1 500 1 000 500 0

Baseline Increased treatment Increased treatment + efficacy

4 000 3 500 3 000 2 500 2 000 1 500 1 000 500 0

Baseline Increased treatment Increased treatment + efficacy

Figure 23 Projected health care costs (top panel) and indirect cost (low panel) in Romania

Figure 22 shows the estimated number of infected persons in Romania while Figure 23 shows the estimated health care costs and indirect costs under the three different scenarios. Although the number of prevalent cases is expected to decrease, health care costs are expected to increase under all three scenarios and only when increased treatment is combined with more effective drugs will health care costs start decreasing before 2040.

By combining higher treatment uptake with more effective treatment, health care costs in Romania are projected to be reduced by almost 50% by 2040 compared to current treatment levels.

million €million € 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

180 000 160 000 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0

Health care costs Drug costs Indirect costs Total cost Baseline Increased treatment Increased treatment + efficacy

Figure 24 Costs over entire time horizon (2014 - 2040) in Romania¹¹

Total costs accumulated over the entire time horizon are shown in Figure 24. Drug costs are obviously higher in the increased treatment scenario but this is almost entirely offset by reduced health care costs and indirect costs. The total accumulated cost when increased treatment is combined with higher efficacy is also included in the figure.

6.7.3 Similarities and differences between France and Romania

The analysis in both countries shows that investing in increased treatment is a cost-effective option for the health care systems. In France, such investment is completely offset by reduced health care costs and indirect costs. In Romania, the investment in increasing treatment is almost entirely offset by savings in health care costs and indirect costs. The increase in total costs that this would suppose should also be seen in light of the reduced mortality and other complications due to the disease.

In France, extending current standard of care will further reduce the burden of hepatitis C. In Romania, increased treatment must be coupled with more effective drugs in order to curb the otherwise increasing burden of hepatitis C. Currently available and forthcoming drugs present Romania with this opportunity.

11 Note that no extra cost of treatment has been assumed in the scenario in which increased treatment is combined with higher efficacy. Therefore, drug costs and total costs should be interpreted with caution.

Increased drug costs associated with increasing treatment uptake in Romania are almost entirely offset by reduced costs for the health care system and in terms of lost production.

million €

In document Burden of hepatitis C in Europe the case of France and Romania (Page 33-42)