Impact of eradicating hepatitis C virus on the work productivity of chronic hepatitis C (CH-C) patients: an economic model from five European countries.
Younossi Z.
Journal of Viral Hepatitis, 2016; 23, 217–26.

Chronic hepatitis C negatively affects work productivity, creating a large economic burden.
The aim of this study was to develop an economic model to estimate the impact of sustained virologic response on work productivity in chronic genotype 1 HCV infected patients in 5 European countries (France, Germany, Italy, Spain and the United Kingdom). The total number of patients with chronic HCV infection in the 5 countries was estimated from real-world sources.
The anticipated impact of LDV/SOF on productivity loss in each of the 5 European countries was calculated over a one-year period. Patients entered the model post-treatment, after having achieved or not achieved sustained viral response 12 weeks post-treatment completion (SVR12).
Work Productivity and Activity Index-Specific Health Problem (WPAI-SHP) questionnaire was administered to patients across the ION clinical trials (n = 629 European patients). WPAI-SHP data and absenteeism and presenteeism rates were converted into work hours lost via standard assumptions. The total number of work hours lost was then multiplied by the average hourly wage, to calculate the total productivity loss in monetary terms.
The analysis modelled a population of GT1 HCV infected patients over one year, who had been either not treated or treated with LDV/SOF. Sensitivity analyses assessed the possibility that HCV patients’ labour costs were lower than the general population’s and presented results by fibrosis stage. Before initiation of treatment, European patients with HCV GT1 exhibited absenteeism and presenteeism impairments of 3.54% and 9.12%, respectively. For patients not achieving SVR, no productivity gain is assumed. It was also assumed that no untreated patient achieved an SVR. About 91.82% of European patients in the ION trials achieved SVR12 and improved absenteeism and presenteeism impairments by 16.3% and 19.5%, respectively. Monetizing these data, treatment with LDV/SOF resulted in an annual productivity gain of €435 million with a weighted average saving of €409 per patient and a weighted average gain of €900 per employed patient in the 5 European countries. If HCV infected patients are assumed to earn 20% less than the general population, gains of €348 million (€720 per-employment gain) annually are still projected.
The per patient per year and per employed patient per year savings among cirrhotic patients treated with LDV/SOF are projected to be higher compared with noncirrhotic patients across all countries (weighted average savings by number of HCV patients/number of employed HCV patients: €454 per noncirrhotic patient; €696 per employed noncirrhotic patient; €657 per cirrhotic patient; €1597 per employed cirrhotic patient).
Conclusion: Chronic HCV infection results in a significant economic burden to European society. Due to improvements in work productivity, SVR with treatment could provide substantial economic gains, partly offsetting the direct costs related to its widespread use.

Expert's Commentary

« Chronic hepatitis C virus (HCV) infection results in mild to severe, hepatic as well as extra-hepatic, manifestations. Of those patients that are employed, HCV impairs work productivity by 26% to 30% and induces an economic burden on patients, their employers and society.
Since few studies have assessed the economic burden of the condition from the European patient perspective, the aim of this analysis was to evaluate the productivity loss due to HCV chronic infection in genotype 1-infected patients. An economic model was developped to estimate the work productivity-related gains costs and the potential savings due to improved work productivity resulting from achieving a sustained virologic response (SVR12) with treatment in France, Germany, Italy, Spain and the United Kingdom (the EU5). Authors conclude that due to improvements in work productivity, SVR could provide substantial economic gains, partly offsetting the direct costs related to its widespread use.
What are the consequences for the physician of such results ?
First, presenteeism (loss of productivity for an employee who is present at work), less known than absenteism, is associated with a significant economical burden. Second, presenteeism was the stronger driver of impairment across cirrhotic and noncirrhotic patients; cirrhosis was projected to be associated with a greater magnitude of work productivity impairment in general and absenteeism in particular. In addition to the benefits on quality of life associated with SVR, improvements in work productivity may induce substantial economic gains : this is an important evidence for the patient information/education since in our daily practice, we are debating with our patients about the high prices and costs of DAAs which explain that access to care is limited in most of countries to « priority » patients. Results of this modelisation provide also strong arguments for the debate with the payers who are mainly considering the cost of the treatment and not taking into account the SVR-economical gains associated with the reduction in extra-hepatic morbidity and mortality or decreased work production. It is noteworthy that the model used in this study had some limitations which may lead to an underestimation of the actual economic benefit of work productivity improvement due to HCV cure. If we cannot deny the high costs of therapies, the cost-effectiveness of these treatments in patients with significant hepatic and extra-hepatic manifestations, the benefits associated with SVR regarding quality of life (physical as well as psychological items), work productivity and the reductions of hepatic and extra-hepatic mortality and morbidity which is cost-saving, must allow us to reinforce screening and link to care in most of HCV infected patients.»

Pr Stanislas Pol
Université Paris Descartes; Hepatology Department, Cochin hospital, APHP
INSERM U-818 and UMS-20, Institut Pasteur, Paris, France