A cost analysis of a simplified model for HCV screening and treatment at a tertiary hospital in Zimbabwe

Figures & data

Figure 1. Schematic for the simplified model of care for HCV screening and treatment RDT-rapid diagnostic test, NAT-nucleic acid test, HCV-hepatitis C virus, FBC-full blood count, INR-international normalized ratio, HBVsAg- hepatitis B virus surface antigen, APRI – aspartate transaminase-to–platelet ratio index, SVR- sustained virologic response.

Table 1. Unit costs for activities and the model of care*.

Visit	Activities	Type	Unit Cost/$
HCV screening	Demographic and behavioral data collection	Staff time	0.19
	Pretesting counseling	Staff time	0.76
	HCV RDT test and provision of results	Staff time/Materials	2.57
	Post testing counseling	Staff time	0.76
	Phlebotomy for HCV NAT testing	Staff time/materials	0.94
	HCV NAT test	Outsourced	54
Treatment eligibility Assessment	Issue of HCV NAT test results and counseling	Staff time	0.19
	Phlebotomy for pre-treatment tests	Staff time/Materials	1.04
	Pregnancy test and family planning counseling	Staff time and materials	1.38
	Alcohol intake assessment	Staff time	0.19
Treatment Initiation	Review of patient laboratory results and behavioral data	Staff time	0.95
	Fibrosis assessment using APRI score	Staff time	0.95
	Writing of DAAs prescription	Staff time	0.23
	Dispensation of DAAs at the pharmacy	Staff time/Materials	705
	Adherence Counselling	Staff time	0.57
Drug Refill visit	Review of adverse events	Staff time	0.95
	Management of adverse events	Staff time	1.20
	Pill count and adherence counseling	Space/Materials	0.24
End of treatment	End of treatment counseling	Staff time	0.57
	End of treatment alcohol intake assessment	Staff time	0.38
	Phlebotomy for laboratory tests	Staff time	0.95
	Pill count and documenting adherence	Staff time	0.24
SVR test	Phlebotomy for SVR test	Staff time	0.95
	Phlebotomy for laboratory tests	Staff time/Materials	0.95
	HCV NAT test	Outsourced	54
	SVR result disclosure	Staff time	0.38

*Unit costs in 2019 United States Dollars, HCV RDT-Hepatitis C virus rapid diagnostic test, HCV NAT-hepatitis C virus nucleic acid test, DAAs – directly acting antivirals.

Table 2. Unit costs for laboratory tests and medicines the model of care*.

	Resource type	Source	Unit Cost
Laboratory tests
Liver function tests full panel	Laboratory test	Internal	8.23
Full blood count (FBC)	Laboratory test	Internal	7.04
Urine, electrolytes and creatinine	Laboratory test	Internal	7.40
Creatinine clearance	Laboratory test	Outsourced	11
Glucose random plasma	Laboratory test	Internal	11
Hepatitis B surface antigen (HBVsAg)	Laboratory test	Outsourced	17
HCV NAT	Laboratory test	Outsourced	54
HCV Genotyping	Laboratory test	Outsourced	786
Haemoglobin	Laboratory test	Outsourced	18
HCV Rapid diagnostic test	Laboratory test	Internal	2.57
Fibrosis Assessment (APRI)	Laboratory test	Internal	9.19
Pregnancy test	Laboratory test	Internal	1.38
Prothrombin/International Normalized Ratio (PT/INR)	Laboratory test	Outsourced	15
Medicines
Sof/vel 28s	DAA medicines	Outsourced	470
Sof/dcv 28s	DAA medicines	Outsourced	442
Ldv/sof 28s	DAA medicines	Outsourced	375

*Unit costs presented in 2019 US$.

HCV-hepatitis C virus, HBVsAg- hepatitis B virus surface antigen, HCV-NAT-Hepatitis C virus nucleic acid test, DAAs-directly acting antivirals, Sol/vel- Sofosbuvir/velpatasvir, Sof/dcv – sofosbuvir/daclatasvir, Ldv/sof-ledipasvir/sofosbuvir.

Table 3. Total costs for the visits and model of care for hepatitis C virus infection at tertiary hospital*.

	Sof/vel-12 weeks	Sof/dcv-12 weeks
Visit 1 : HCV Testing (RDT and NAT)
Cost of HCV RDT	13.13	13.13
Cost of HCV NAT	54.19	54.19
Total cost of case finding	819	819
Visit 2:Treatment eligibility assessment
Laboratory tests	87	87
Staff time	3.79	3.79
Medicines	-	-
Overheads	8.16	8.16
Total visit cost	98.95	98.95
Visit 3: Treatment Initiation
Laboratory tests Cost	-	-
Staff time	3.25	3.25
Medicines	705	663
Overheads	8.16	8.16
Total visit cost	716.41	674.41
Visit 4:Treatment follow-up
Laboratory tests Cost	-	-
Staff time	3.03	3.03
Medicines	705	663
Overheads	8.16	8.16
Total visit cost	716.19	674.19
Visit 5: End of Treatment
Laboratory tests cost	-	-
Staff time	1.29	1.29
Medicines	-	-
Overheads	8.16	8.16
Total visit cost	9.45	9.45
Visit 6: SVR12 Test
Laboratory tests cost	69	69
Staff time	2.72	2.72
Medicines	-	-
Overheads	8.16	8.16
Total visit cost	79.88	79.88
Visit 7: SVR12 result disclosure
Laboratory tests cost	-
Staff time	0.45	0.45
Medicines	-	-
Overheads	8.16	8.16
Total visit cost	8.61	8.61
Total cost of screening and treatment(all visits)	$2 448 (290)^**	$2 364 (263)^**
DAA SVR (from literature) [2]	0.96	0.92
Total cost per patient/SVR/$	$2 550	$2 569

*Total costs presented in 2019 United States Dollars, HCV-hepatitis C virus, RDT-rapid diagnostic test, NAT-nucleic acid test, Sol/vel- Sofosbuvir/velpatasvir, Sof/dcv – sofosbuvir/daclatasvir, SVR-sustained virologic response, DAA-directly acting antiviral.

** Standard deviation.

Figure 2. Tornado diagram showing the impact of changes in parameters on the total cost of care in a deterministic sensitivity analysis. SVR-sustained virologic response, DAAs-directly acting antivirals.

Figure 3. Tornado diagram showing the impact of changes in estimates to the total cost of diagnosis. HCV-hepatitis C virus, HCV-RDT- hepatitis C virus rapid diagnostic test, HCV-NAT- hepatitis C virus nucleic acid test.

Figure 4. Sensitivity analysis spider diagram showing the most influential inputs to the total cost per SVR. DAA–directly acting antivirals, SVR-sustained virologic response.

World Health Organization. Updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics. Geneva (Switzerland): WHO; 2022.

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