In Egypt, there is a scarcity of published evidence about the economic burden of CHB. The current study depends on the data collected from the General Administration of Hepatitis Viruses Control, Egypt to formulate an overview about the health care utilization and annual direct medical costs incurred by the health sector for management of CHB.
Our findings show that the total annual direct medical costs due to CHB in Egypt is 4.7 Int$ billion/year for the management of estimated 1,420,700 patients in the whole population. These findings are different from the results of a study carried out in Singapore, 2009 [20], where the total annual direct costs incurred due to CHB were 161 $ Million for estimated 209,305 patients. Moreover, in a study about CHB economic burden in Vietnam, 2012 [21], the annual direct medical costs reached 4.0 $ Billion for estimated 8,651,497 patients.
The wide difference in patients’ number between countries and subsequently the annual costs is attributed to introducing hepatitis B vaccination in the national childhood immunization program in Singapore in 1985 which led to a great reduction in the disease prevalence while Egypt introduced it in 1992 [19, 22]. Additionally, Vietnam is considered as a high endemic country for HBV with a prevalence rate 15% [23].
In the current study, the maximum utilization of outpatient visits is incurred in the liver transplantation clinical stage while in a study carried out in the USA, 2019 [24], the highest frequency is incurred among HCC patients.
Our findings demonstrate that the patient in decompensated cirrhosis and hepatocellular carcinoma clinical stage has around 6 incidents of hospital admission/year with an average hospital stay of 14 days in each incident. These findings are consistent with the study in Vietnam in 2012 [21] where HCC patients experienced (2–6) hospitalization incidents/year with an average of (10–14 days) of hospital stay. However, in the study in the USA, 2019 [24], the hospitalization incidents ranged from 3–4 incidents/year in the same clinical stages with an average hospital stay of 6–10 days/incident. Additionally, in a study about Chinese CHB patients during 2015 [25], the average duration of hospital stay was 33 days.
The current study clarifies that the annual cost/patient increases according to disease progression from chronic hepatitis to liver transplantation stage (18.093–718.200 Int$/year respectively). In the study of Singapore [20], there was a doubling in the direct medical costs with disease progression from chronic hepatitis to liver transplantation clinical stage. Additionally, in a study carried out in Japan, 2021 about the economic burden of CHB [26] the average annual cost incurred/patient was 1,332,417±2,049,712 Japanese Yen irrespective of the clinical stage.
In the current study the average annual direct medical cost/patient regarding outpatient visits, laboratory investigations, treatment, and hospitalization is 59- 3.197- 2.993- 5.600 Int$/year respectively. The health care costs in Egypt are lower than the costs reported in the study of Japan [26] where it was 711.523- 168.466- 633.063- 621.894 Japanese Yen for the same categories respectively. The Japanese study calculated the cost for 11,125 CHB patients.
Regarding the total annual direct costs/patient according to different stages of CHB related disease, the current study reported 18.093- 18.587- 58.493- 72.973- 718.200 Int$ for chronic hepatitis, compensated cirrhosis, decompensated cirrhosis, HCC, and liver transplantation respectively. The costs reported in the study of Vietnam [21] were higher for the same clinical stages (450.35- 690.43- 1114.50- 1883.05 respectively) without considering the liver transplantation clinical stage.
In our study, the annual direct medical costs incurred in chronic hepatitis, decompensated cirrhosis, HCC, and liver transplantation clinical stage in the working-age group are 1.5, 0.37, 0.32, and 0.001 Int$ Billion respectively for estimated 756,553 patients. However, the annual direct medical costs reported for the same clinical stages in the USA [24], China [2], and Southern Iran [27] were lower than our study findings.
In the study about the economic burden among US CHB patients in 2019 [24], the costs for the same clinical stages were $142,870, $124,123, and $171,851 respectively for a sample of 33,904 CHB patients. In the study of China [2] the lower cost is attributed to the availability of affordable oral antivirals for Hepatitis B treatment as a part of a nation-wide strategy in China towards zero new hepatitis B infections [28]. In the study of Southern Iran [27], the costs reported for CHB, cirrhosis, and HCC were US$ 30.945, US$17.483, and US$ 32.958, respectively, for 100 CHB patients. All these studies weren’t focusing on the productive age group economic burden.
The wide range of differences regarding the frequency of health care resources utilization and their costs among different countries can be explained by the variation of the methodology of cost assessments, the differences in treatment protocols adopted, and the prices of healthcare goods in each country in addition to a variety of fiscal years among studies. Moreover, the currency of the direct medical costs was not standardized in all studies which makes the comparison more difficult [29].
The direct medical costs of CHB patients among the productive age group (25–59 years) constitute 57% of the total cost in the current study. The highest disease burden is reported among 25–29 years age group which is 0.5 Int$ billion/year. These results are consistent with a study carried out in Togo, West Africa [30] where the highest burden of HBV is reported among 20–29 years, age group. However, in the USA, the disease causes a higher burden among the elderly [31].
The main limitation of the current study is the inability to estimate the indirect cost of CHB in Egypt due to a lack of data on productivity loss secondary to CHB. Additionally, extrapolation of the findings to the population level was done without adjustment to the contextual factors (e.g., occupation and residency).
Finally, the inability to compare the current study results with previous Egyptian studies due to lack of published data about the CHB economic burden in Egypt.