Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Tropical Medicine

Background: HCV infection imposes a huge economic burden in Egypt.An integral part of this economic burden is the cost of the pretreatment assessment which includes a full laboratory assessment. So there is a great need in finding a way to minimize the cost of pretreatment assessment. Aim:To evaluate the real life application of Fibrosis-4 score (FIB-4) as a cheap and accurate method of pretreatment assessment for Egyptian patients with Chronic HCV infection. Methods:This study was conducted on 981 subjects with chronic HCV infection.A comparative cost analysis study was done between:A)The current Egyptian model of care set by the NCCVH, which categorizes patients into easy or difficult to treat using full laboratory assessment. AndB)The proposed model of care using FIB-4 which categorizes patients into easy or difficult to treat using a cutoff of 3.25. Results: In our cohort when we divided the patients into "easy" and "difficult" to treat using the current standard protocol of NCCVHwe did not find a significant relation as regard laboratory assessment. When we divided patients into "easy" and "difficult" to treat using FIB-4 we found a significant relation as regard total bilirubin and hemoglobin. We calculated the average cost effectiveness ratio (ACER) to compare the average cost per truly categorized patient by either screening strategies. Where, it was estimated to be 85 LE/ patient for the current Egyptian model using full labs compared to 71 LE/ patient for FIB-4 based model.We compared the total cost of treatment using the current standard protocol of NCCVH in dividing patients into "easy" and "difficult" to treat and using FIB-4 at a cutoff of 3.25 in dividing patients into "easy" and "difficult" to treat.We found that using the FIB-4 model would save around 400,000 L.E

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