title: Health Economics Evaluation for hepatitis C in Vietnam
Creators: name: Nguyen, Huyen Anh
Publisher: name: The Open University
Year: 2024

description: Hepatitis C is a chronic infectious disease that causes liver disease. It remains a significant public health problem, with an estimated 58 million people infected worldwide. Recent advancements in Direct-Acting Antiviral (DAA) based treatment have shown higher cure rates (&gt;90%) and fewer side effects compared to the previous treatment options. However, in Vietnam, only 2,700 patients accessed DAA (through the public hospital system and national health insurance) in 2020, despite an estimated 970,000 to 4 million people with chronic Hepatitis C. The high cost of DAA-based treatment poses a significant barrier to accessibility and raises questions about the fairness and affordability of Hepatitis C treatment.
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My PhD project aims to assess the total costs of chronic Hepatitis C treatment with DAA in Vietnam and to evaluate its cost-effectiveness analysis (CEA) over a lifetime horizon under different perspectives. I also assess out-of-pocket payments (OOP) incurred by patients.
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This PhD project is structured across four distinct chapters. The first chapter aims to assess the outpatients’ costs for accessing hepatitis C treatment, including their direct non-medical costs and productivity costs. Additionally, it aims to investigate the differences in these costs between outpatients living in Ho Chi Minh City (HCMC) and other Southern provinces (OSP), along with the corresponding equity implications. These costs were collected between 2020-2021 through face-to-face interviews with 102 patients at the Hospital for Tropical Diseases (HTD) in HCMC, Vietnam. I found a notable cost disparity between the costs incurred by patients from HCMC vs OSP, with patients from OSP incurring double the costs. This cost gap widens further if outpatients travelled with caregivers.
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The second chapter investigates the full cost of DAA treatment, including drug costs and service costs. It aims to explore the drivers in the total cost of DAA-based treatment and compare this with the previously used Peg-Interferon treatment. We collected drug cost and service cost data between 2021-2022, primarily from the HTD database in HCMC. The total cost of DAA based treatment ranged from US$1331.5 to 1939.35, with direct medical costs being the most significant driver (US$971.16 to 1578.7). The drug costs were notably higher than in other Southeast Asian countries. Despite most outpatients having health insurance (&gt;98%), OPP expenses remain significant, ranging from 47% to 100% of total DAA treatment costs.
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In the third chapter, I combined the cost findings from the preceding two parts and developed a health economic evaluation model to perform a CEA. Disability Adjusted Life Years (DALY) were used as the health outcome measure. This model was designed to simulate the long term cost and health outcomes under different perspectives and treatment options (DAA/ Peg-Interferon/No treatment), accounting for the cost of re-treatments. I found that among different DAA treatment options, the combination of Sofosbuvir/Velpatasvir was the most cost-effective. Over the long term, DAA based treatments result in cost savings compared to both the no treatment option and Peg-Interferon-based treatment.
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The final chapter aims to assess OOP payments incurred by patients and the incidence of catastrophic health expenditure (CHE) among the sampled hepatitis C outpatients. Following different DAA treatment options, I aim to identify the effects of health insurance coverage on OOP payments and CHE. I also discuss the various methods used to measure CHE. A high rate of CHE (estimated with a budget share approach) was observed in 89% of the sample. Health insurance coverage would need to be expanded, from 83% to 97%, instead of the current 50% of DAA drug cost, to protect people from CHE.
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In conclusion, actions are needed to reduce the DAA drug cost and OOP expenditure, especially targeting outpatients living outside major cities. Initiatives such as encouraging local DAA production, supporting decentralized hepatitis C treatments, and increasing health insurance coverage are needed. When it comes to DAA based treatments, there's a strong incentive to treat a larger portion of the population to achieve long-term cost savings.