Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2019; 25(11): 1327-1340
Published online Mar 21, 2019. doi: 10.3748/wjg.v25.i11.1327
Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals
Ilias Gountas, Vana Sypsa, George Papatheodoridis, Kyriakos Souliotis, Kostas Athanasakis, Homie Razavi, Angelos Hatzakis
Ilias Gountas, Vana Sypsa, Angelos Hatzakis, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
Ilias Gountas, Angelos Hatzakis, Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens 11527, Greece
George Papatheodoridis, Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece
Kyriakos Souliotis, Faculty of Social and Political Sciences, University of Peloponnese, Korinthos 20100, Greece
Kostas Athanasakis, Department of Health Economics, National School of Public Health, Athens 11521, Greece
Homie Razavi, Center for Disease Analysis, Lafayette, CO 80026, United States
Author contributions: Gountas I and Hatzakis A conceived the study; Gountas I performed the modelling and drafted the manuscript; Hatzakis A coordinated the study; Sypsa V, Papatheodoridis G, Souliotis K, Athanasakis K and Razavi H provided essential inputs and contributed extensively to writing the manuscript; All authors contributed to model interpretation and approved the final version.
Conflict-of-interest statement: No conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Angelos Hatzakis, PhD, Doctor, Senior Researcher, Senior Scientist, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 22 Mikras Asias Str., Athens 11527, Greece.
Telephone: +30-210-7474058 Fax: +30-210-7474058
Received: October 16, 2018
Peer-review started: October 16, 2018
First decision: December 5, 2018
Revised: February 20, 2019
Accepted: February 22, 2019
Article in press: February 22, 2019
Published online: March 21, 2019

Hepatitis C virus (HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral (DAA) treatment coverage, to compute the total costs (including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.


To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.


A previously validated mathematical model was adapted to the Greek HCV-infected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs (direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.


Without the implementation of awareness or screening campaigns, approximately 20000 patients would be diagnosed and treated with DAAs by 2030. This strategy would result in a 19.6% increase in HCV-related mortality in 2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by 78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros (€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very cost-effective. Furthermore, HCV elimination strategy would save €560-895 million by 2035.


Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.

Keywords: Hepatitis C elimination, Cost effectiveness, Cost of elimination, Indirect costs, Projections, Mathematical modelling, Awareness and screening programs, World Health Organization targets

Core tip: Elimination of hepatitis C virus (commonly known as HCV) cannot be achieved in Greece without the implementation of large awareness and screening programs, as treatment coverage will be suboptimal. To achieve the elimination goals, 90000 patients need to be treated by 2030. The overall cumulative cost of elimination would range from 3.2-3.4 billion euros by 2030. The HCV elimination strategy in Greece is feasible and cost-saving despite the uncertainty of the future cost of the direct-acting antivirals.