CRES Seminar - Nikos Kotsopoulos

CRES Seminar - Nikos Kotsopoulos

Assessing the public economic impact of hepatitis C therapy in Spain

  • Date: October, 31st. At 10:30h.
  • Room: tba (Ciutadella Campus, Mercè Rodoreda Building. Universitat Pompeu Fabra, Barcelona)




 Background: Hepatitis C infection (HCV) results in long-term public costs which consist of healthcare costs and social protection costs, including disability pensions and allowances for incapacitated cirrhotic patients. Moreover, advanced HCV has a detrimental impact on patients’ productivity resulting in lower lifetime earnings and hence, lower tax revenues for the government. Recent economic analyses in the UK suggest that early, curative HCV therapeutic interventions may be both cost-effective and fiscally feasible, since they may have positive public economic effects which are not captured by conventional health economic analyses. Study objective: The objectives of this study were [1] to quantify the long-term public economic effects of HCV therapy [2] to compare the public economic effects of treating HCV patients early that is, patients with low Fibrosis (F) scores (F0-F1), versus treatment at late stages (F2-F4) [3] to assess the costs and benefits of current and future treatment programs for the public budget in Spain. Study methods & data: Adjustment of a cohort-based, Markov, cost-effectiveness model, simulating the natural history of HCV infection, to produce lifetime, discounted healthcare and social protection costs and tax revenues for cohorts of HCV patients, aged 40, receiving treatment with 98.4% efficacy and treatment cost of €43K. Healthcare and other public economic data were obtained from published sources and discounted at 3%. Study results: Compared to not providing HCV patients with therapy, HCV therapy is expected to produce healthcare cost-savings of €25,8K per patient, social protection cost-savings of €22,6K per patient and incremental lifetime tax gains of €12,9K per patient, suggesting a positive public return on investment (ROI) of 1.4. Compared to late treatment, early treatment is expected to result in healthcare and social protection costs-savings of €35,2K over the lifetime of an average HCV patient in addition to the tax gain of €5,2K per patient. The ex-post analysis of the national HCV treatment plan for 2015 shows that every €1 spent on HCV treatment is expected to return €1.5 in public cost-savings and tax revenue gains.

Study conclusions: Investing in HCV therapy appears to have positive public economic effects in Spain. From a public budget’s perspective, early intervention appears to be a fiscally dominant strategy. Treating HCV patients early, is expected to result in better patient outcomes and public economic effects compared to treating patients late since early treatment may result in healthcare and social protection cost-savings and tax gains from increased patient’s productivity.




Nikolaos (Nikos) Kotsopoulos is a health economist with 15 years of experience in the pharmaceutical industry and related consulting. Nikos is a partner at Global Market Access Solutions, with licensed offices in Switzerland, UK and US. In the past, he has held global and regional positions for the pharmaceutical industry and has conducted several health economic studies in both developed and developing countries. He also is a guest lecturer at the University of Athens, School of Public Policy and Administration. In recent years, he has contributed to the development of a novel analytic framework that assesses the macroeconomic and fiscal effect of investments in healthcare. The analytic framework developed by Nikos and his team has been incorporated into the WHO framework on broader impact of vaccination to inform decision-makers. He has received formal post-graduate training in health economics at the University of Groningen (PhD), and City University, London (MSc).