THE ECONOMIC IMPACT OF TREATING CHRONIC HEPATITIS C

Hepatitis C is a viral infection of the liver. This infection is a global problem because over 180 million people worldwide have chronic hepatitis type C (about 3% of the world's population). The highest prevalence occurs among intravenous drug addicts (about 52%), the virus can be transmitted from mother to child during childbirth (4-8%), and further the virus is transmitted through medical interventions, piercing, tattooing. In the Republic of Macedonia in the period from 2011 to 2017, 511 newly infected with Hepatitis C from a total of 31 municipalities were registered. Among the healthy population in Macedonia, 0.4% were positive for HCV, while among the risk groups, 23% -52% were positive for HCV. In Macedonia, the groups at highest risk of HCV are: people who inject drugs (with a prevalence of 51.53%), people who are being treated with hemodialysis (with a prevalence of 37.91%), people who have become infected with HCV by transfusion (with a prevalence of 1,48%), people who have become HCV infected in other risky ways (with a prevalence of 9,08%). Hepatitis C virus is a serious health, but also an economic problem. Treatment of hepatitis C is expensive and therefore hardly accessible to people motivated to heal from hepatitis C. Тhe treatment of patients with chronic hepatitis C was performed with a combination of pegylated interferon alfa and ribavirin (dual therapy) for 24 or 48 weeks. Early detection of HCV infection is very important, because chronic hepatitis C is already a treatable disease, until the stage of decompensated cirrhosis and / or HCC. Disease control is successfully achieved by 30-60% with standard interferon, 40-70% depending on the genotype with pegylated interferon (in combination with ribavirin), and 40-90% with new direct-acting antivirals (DAAs). In addition, the benefit of treatment is that it reduces the risk of further spread of the virus. Treatment with the most recent direct-acting drugs (DAAs) started in 2011, lasts much shorter, 12 to 24 weeks, has the least risky effects and the highest percentage of negativity (up to 90%) but is not yet widely used (expensive in many countries not yet registered ). For example, sophosuvir is only regressed in some richer countries, and treatment with it costs about $ 84,000 ($ 1,000 per pill). In 2011, treatment with Copegus and Pegasus for 48 weeks of treatment, for patients under 75 kg, required a total of 1,215,974 MKD (44,831 MKD cost per one Copegus package and 15,993 MKD for a Pegasus injection). For patients over 75 kg the total cost is 1,305,636 MKD. For genotype 2 and 3 the total costs for all patients regardless of body weight were 563,156 MKD. Total costs in 2017 for Copegus and Pegasus for 48 weeks of treatment for patients with Hepatitis C genotype 1 and 4 in Macedonia cost 655,964 MKD, which means a 46% decrease compared to 2011.