TABLE 3.
Unit costs of components of screening and treatment program (USD by year)
| 2015 | 2016 | 2017 | Source for cost estimates | |
|---|---|---|---|---|
| Direct costs (per patient treated) | ||||
| Screening testa | $5.1 | $4.1 | $22.6 | NCDC |
| MOH share | 15% | 12% | 25% | |
| Private health facility share | 85% | 88% | 75% | |
| HCV RNA testa | $54.2 | $41.9 | $42.6 | MOH financial reimbursement records |
| MOH share | 34% | 33% | 34% | |
| Patient share | 66% | 67% | 66% | |
| Pre-treatment evaluation with FIB-4 onlya | $38 | $112 | $111 | MOH financial reimbursement records |
| MOH share | 65% | 31% | 34% | |
| Patient share | 35% | 69% | 66% | |
| Pre-treatment evaluation with elastographya | $92 | $136 | $141 | MOH financial reimbursement records |
| MOH share | 35% | 30% | 34% | |
| Patient share | 65% | 70% | 66% | |
| Treatment monitoring visits and blood testsa | $176 | $104 | $27 | MOH financial reimbursement records |
| MOH share | 17% | 27% | 30% | |
| Patient share | 83% | 73% | 70% | |
| Non-DAA drugs (ribavirin/interferon) | $313 | $48 | $33 | List price in Georgia |
| MOH share | 100% | 100% | 100% | |
| DAA drugs (list price) | $93 008 | $72 129 | $84 294 | |
| DAA drugs (generic) | $1029 | $1043 | $1047 | |
| DAA drugs (minimal) | $47 | $59 | $60 | |
| Indirect costs (total per year) | ||||
| Outreach | $70 462 | $48 235 | $21 880 | MOH and NCDC records |
| Logistics | $35 983 | $190 840 | $158 661 | |
| MOH share | 100% | 100% | 100% | |
| Costs for clinic equipment | $16 942 | $16 942 | $16 942 | MOH records |
| Clinic share | 100% | 100% | 100% | |
| Liver disease care (per patient receiving care) | ||||
| Mild | $318 | $281 | MOH records from the Management of Infectious Diseases state program | |
| MOH share | 86% | 885 | ||
| Patient share | 14% | 12% | ||
| Moderate | $427 | $392 | ||
| MOH share | 91% | 86% | ||
| Patient share | 9% | 14% | ||
| Severeb | $675.5 | $689.8 | ||
| MOH share | 88% | 89% | ||
| Patient share | 12% | 11% | ||
Abbreviations: DAA, direct-acting antivirals; MOH, Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs; NCDC, National Center for Disease Control.
Screening, diagnostic and pre-treatment evaluation costs were calculated per patient treated according to a cascade of care. The breakdown of costs between MOH and patients is weighted by the proportion of treatments for patients designated as socially vulnerable, which varied by year (15.3% in 2015, 9.3% in 2016 and 12.3% in 2017). See Data S1 for additional details on variation in patient out-of-pocket costs.
Severe liver disease includes cirrhosis, ascites and/or encephalopathy and/or hepato-renal syndrome.