Background/Aims The first metabolic dysfunction-associated steatotic liver disease (MASLD) drug was approved with an unsatisfactorily small effect size. This study aimed to determine key factors impacting the cost-effectiveness of a new hypothetical MASLD drug as well as its treatment efficacy.
Methods A Markov model reflecting the natural history of MASLD was developed, incorporating fibrosis progression, cardiovascular disease risk, and mortality. Treatment effect of drug X (with $20,000 of annual cost) was assumed to achieve a ≥1 stage fibrosis regression, with a 25% gap of effect size in regression rate over non-treatment in the first year. The incremental cost-effectiveness ratio (ICER) over a 20-year horizon was estimated. And sensitivity analyses were conducted to explore uncertainty and identify influential factors.
Results In the base case analysis, drug X provided an incremental gain of 1.32 quality-adjusted life years (QALYs) and 1.20 life years compared to the non-treatment, with an ICER of $68,010/QALY–below the $100,000/QALY willingnessto- pay threshold, indicating that drug X treatment is cost-effective. Two-way sensitivity analysis further highlighted that the drug should achieve at least a 15% initial regression gap and maintain a minimum 3% sustained durability gap to remain cost-effective. In addition baseline fibrosis stage distribution also acted as an influencing factor.
Conclusions Long-term sustained durability of the hypothetical drug, patient distribution based on baseline fibrosis stage, as well as initial treatment response rate are key factors that influence the cost-effectiveness of new MASLD drugs.
Chang Hun Lee, Gwang Hyeon Choi, Hwa Young Choi, Sojung Han, Eun Sun Jang, Young Eun Chon, Young Chang, Kyung-Ah Kim, Do Young Kim, Hyung Joon Yim, Hye-Lin Kim, Sook-Hyang Jeong, In Hee Kim
Clin Mol Hepatol 2023;29(3):779-793. Published online May 15, 2023
Background/Aims To eliminate hepatitis B virus (HBV) and hepatitis C virus (HCV) according to the World Health Organization (WHO) criteria in 2021, this study investigated the national core indicators representing the current status of viral hepatitis B and C in South Korea.
Methods We analyzed the incidence, linkage-to-care, treatment, and mortality rates of HBV and HCV infection using the integrated nationwide big data of South Korea.
Results According to data from 2018–2020, the incidence of acute HBV infection in South Korea was 0.71 cases per 100,000 population; tthe linkage-to-care rate was only 39.4%. Among those who need hepatitis B treatment, the treatment rate was 67.3%, which was less than 80% reported in the WHO program index. The annual liver-related mortality due to HBV was 18.85 cases per 100,000 population, exceeding the WHO target of four; the most frequent cause of death was liver cancer (54.1%). The annual incidence of newly diagnosed HCV infection was 11.9 cases per 100,000 population, which was higher than the WHO impact target of five. Among HCV-infected patients, the linkage-to-care rate was 65.5% while the treatment rate was 56.8%, which were below the targets of 90% and 80%, respectively. The liver-related annual mortality rate due to HCV infection was 2.02 cases per 100,000 population.
Conclusions Many of the current indicators identified in the Korean population did not satisfy the WHO criteria for validation of viral hepatitis elimination. Hence, a comprehensive national strategy should be urgently developed with continuous monitoring of the targets in South Korea.
Citations
Citations to this article as recorded by
Implementation of an alert system for the care cascade of Hepatitis C infection in patients undergoing elective surgery Jae Seung Lee, Ho Soo Chun, Hye Won Lee, Mi Na Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim Journal of Infection and Public Health.2026; 19(2): 103076. CrossRef
AI-Safe-C score: Assessing liver-related event risks in patients without cirrhosis after successful direct-acting antiviral treatment Huapeng Lin, Terry Cheuk-Fung Yip, Hye Won Lee, Xiangjun Meng, Jimmy Che-To Lai, Sang Hoon Ahn, Wenjing Pang, Grace Lai-Hung Wong, Lingfeng Zeng, Vincent Wai-Sun Wong, Victor de Lédinghen, Seung Up Kim Journal of Hepatology.2025; 82(3): 456. CrossRef
Burden, trends, and predictions of liver cancer in China, Japan, and South Korea: analysis based on the Global Burden of Disease Study 2021 Si Yang, Yujiao Deng, Yi Zheng, Jing Zhang, Dongdong He, Zhijun Dai, Changcun Guo Hepatology International.2025; 19(2): 441. CrossRef
Contemporary awareness of viral hepatitis between 2012 and 2022 among Korean adults Donghee Kim, Won Kim, Aijaz Ahmed Clinical and Molecular Hepatology.2025; 31(1): e5. CrossRef
Etiologic, epidemic, medical and economic aspects of hepatocellular carcinoma N. A. Vlasova, V. I. Apanasevich, E. V. Eliseeva, S. S. Startsev Сибирский научный медицинский журнал.2025; 45(1): 6. CrossRef
HCV self-testing: Bridging screening gaps and ensuring cost-effectiveness for both high-risk and universal populations: Correspondence to editorial on “Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of dis Gyeongseon Shin, Beom Kyung Kim, SeungJin Bae, Hankil Lee, Sang Hoon Ahn Clinical and Molecular Hepatology.2025; 31(2): e163. CrossRef
Universal self-testing as a cost-effective weapon to eliminate hepatitis C virus in the Republic of Korea: Editorial on “Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of disease burden and cost-effectiven Eun Sun Jang Clinical and Molecular Hepatology.2025; 31(2): 596. CrossRef
Temporal and geospatial patterns of hepatitis C virus prevalence: a longitudinal examination using national health insurance service data in the Republic of Korea (2005–2022) Hwa Young Choi, Moran Ki BMC Public Health.2025;[Epub] CrossRef
Correspondence to letter to the editor on “Contemporary awareness of viral hepatitis between 2012 and 2022 among Korean adults” Chang Hun Lee, In Hee Kim, Sook-Hyang Jeong Clinical and Molecular Hepatology.2025; 31(2): e149. CrossRef
Incidence of Osteopenia or Osteoporosis in Asian Patients With Chronic Hepatitis B Hye Won Lee, Sungshin Kwon, Yeo Rae Moon, Hyunjung Ahn, Juyeon Lee, Sang‐Hoon Ahn Journal of Gastroenterology and Hepatology.2025; 40(6): 1586. CrossRef
A 2024 global report on national policy, programmes, and progress towards hepatitis B elimination: findings from 33 hepatitis elimination profiles Lindsey Hiebert-Suwondo, Jana Manning, Rania A Tohme, Maria Buti, Loreta A Kondili, C Wendy Spearman, Nishi Prabdial-Sing, Victoria Turnier, Jeffrey V Lazarus, Imam Waked, John W Ward, Angelica Miranda, Aya Sugiyama, Behzad Hajarizadeh, Carlos Varaldo, Ca The Lancet Gastroenterology & Hepatology.2025; 10(7): 671. CrossRef
Service delivery models and care cascade outcomes for people living with chronic hepatitis B: a global systematic review and meta-analysis Alexander J Stockdale, Bethany Holt, Ajeet Singh Bhadoria, Abhishek Sadasivan, Daniel Ikeda, Todd Pollack, Janus P Ong, Thuy Pham, David B Duong, Vy Nguyen, Gibril Ndow, Roger Chou, Philippa Easterbrook The Lancet Gastroenterology & Hepatology.2025; 10(11): 1013. CrossRef
Prevalence, Clinical Characteristics, and Treatment Status of Hepatitis C Virus Infection among People Who Use Drugs in South Korea: A Prospective Multicenter Study Gwang Hyeon Choi, Young-Hoon Chon, Do Hoon Kwon, Sung Nam Jo, Og-Jin Jang, Kyung-Ah Kim, Dahye Baik, Eun Sun Jang, Sook-Hyang Jeong Gut and Liver.2025; 19(5): 725. CrossRef
Etiological, Epidemiological, and Medical-Economic Aspects of Hepatocellular Carcinoma (A Review) N. A. Vlasova, V. I. Apanasevich, E. V. Eliseeva, S. S. Startsev Cell and Tissue Biology.2025; 19(6): 525. CrossRef
Monitoring and evaluation of community interventions for viral hepatitis among migrants and refugees: a Delphi-based study Domenico Pascucci, Aina Nicolàs, Abdelrahman Taha, Jeffrey V Lazarus, Matteo Di Pumpo, Vittoria Tricomi, Francesco Di Berardino, Carlo La Vecchia, José A Perez-Molina, Giuseppe Colucci, Camila A Picchio, Angelo Maria Pezzullo, Stefania Boccia Journal of Global Health.2025;[Epub] CrossRef
Disease burden of chronic hepatitis B and C patients in South Korea: a population-based 16-year cohort study Oeuk Jeong, Changhee Chu, Jungyeon Kim, Jae Seung Lee, Jun Yong Park, Kyung Eun Lee, Jaehyun Seong, Min Jin Go BMC Infectious Diseases.2025;[Epub] CrossRef
Effect of direct-acting antivirals on disease burden of hepatitis C virus infection in South Korea in 2007–2021: a nationwide, multicentre, retrospective cohort study Won Sohn, Soo Young Park, Tae Hee Lee, Young Eun Chon, In Hee Kim, Byung-Seok Lee, Ki Tae Yoon, Jae Young Jang, Yu Rim Lee, Su Jong Yu, Won-Mook Choi, Sang Gyune Kim, Dae Won Jun, Joonho Jeong, Ji Hoon Kim, Eun Sun Jang, Hwi Young Kim, Sung Bum Cho, Byoun eClinicalMedicine.2024; 73: 102671. CrossRef
Linvencovir: Paving the way for functional cure in hepatitis B Jiwon Yang, Jonggi Choi Clinical and Molecular Hepatology.2024; 30(2): 164. CrossRef
Higher FIB-4 index at baseline predicts development of liver cancer in a community-based cohort with viral hepatitis Makiko Kimura, Tomoki Nishikawa, Tetsuro Shimakami, Takeshi Terashima, Rika Horii, Masako Fukuda, Mika Yoshita, Noboru Takata, Tomoyuki Hayashi, Masaya Funaki, Kouki Nio, Hajime Takatori, Kuniaki Arai, Tatsuya Yamashita, Masao Honda, Junko Tanaka, Shuichi Global Health & Medicine.2024; 6(6): 404. CrossRef
Activation of Nrf2 and FXR via Natural Compounds in Liver Inflammatory Disease Marta Belka, Aleksandra Gostyńska-Stawna, Maciej Stawny, Violetta Krajka-Kuźniak International Journal of Molecular Sciences.2024; 25(20): 11213. CrossRef
Correspondence to editorial on “Core indicators related to the elimination of hepatitis B and C virus infection in South Korea: A nationwide study” Chang Hun Lee, In Hee Kim, Sook-Hyang Jeong Clinical and Molecular Hepatology.2024; 30(4): 997. CrossRef
Elimination of viral hepatitis: How far are we?: Editorial on “Core indicators related to the elimination of hepatitis B and C virus infection in South Korea: A nationwide study” Eun Ju Cho Clinical and Molecular Hepatology.2024; 30(4): 663. CrossRef
Background/Aims This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives.
Methods A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40–65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40–65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated.
Results The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective.
Conclusions One-time universal HCV screening in the Korean population aged 40–65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives.
Citations
Citations to this article as recorded by
Implementation of an alert system for the care cascade of Hepatitis C infection in patients undergoing elective surgery Jae Seung Lee, Ho Soo Chun, Hye Won Lee, Mi Na Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim Journal of Infection and Public Health.2026; 19(2): 103076. CrossRef
Public value judgments about the criteria for reimbursement of medicines in South Korea Kyung-Bok Son Expert Review of Pharmacoeconomics & Outcomes Research.2025; 25(1): 53. CrossRef
Economic evaluation of mass screening as a strategy for hepatitis C virus elimination in South Korea Hwa Young Choi, Kyung-Ah Kim, Bo Young Park, Bo Youl Choi, Moran Ki Journal of Infection and Public Health.2025; 18(3): 102662. CrossRef
Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of disease burden and cost-effectiveness Gyeongseon Shin, Beom Kyung Kim, SeungJin Bae, Hankil Lee, Sang Hoon Ahn Clinical and Molecular Hepatology.2025; 31(1): 166. CrossRef
Universal self-testing as a cost-effective weapon to eliminate hepatitis C virus in the Republic of Korea: Editorial on “Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of disease burden and cost-effectiven Eun Sun Jang Clinical and Molecular Hepatology.2025; 31(2): 596. CrossRef
HCV self-testing: Bridging screening gaps and ensuring cost-effectiveness for both high-risk and universal populations: Correspondence to editorial on “Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of dis Gyeongseon Shin, Beom Kyung Kim, SeungJin Bae, Hankil Lee, Sang Hoon Ahn Clinical and Molecular Hepatology.2025; 31(2): e163. CrossRef
Cost-Effectiveness of Screening and Treating Chronic Hepatitis C Virus Infection in Zimbabwe Blessing Dzingirai, Leolin Katsidzira, Maarten J. Postma, Marinus van Hulst, Nyashadzaishe Mafirakureva International Journal of Environmental Research and Public Health.2025; 22(4): 509. CrossRef
Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study Meiyu Wu, Jing Ma, Xuehong Wang, Sini Li, Chongqing Tan, Ouyang Xie, Andong Li, Aaron G Lim, Xiaomin Wan Clinical and Molecular Hepatology.2025; 31(2): 394. CrossRef
Cost–benefit analysis of universal screening for HCV infection in China: a Markov modelling study Dachuang Zhou, Liangxiu Xu, Yimei Zhong, Zhehong Xu, Jun Wang, Yuntian Wang, Yiyang Gao, Jing Xie, Yuting Xia, Wenxi Tang BMC Health Services Research.2025;[Epub] CrossRef
HCV elimination in hyperendemic areas: Experiences in Taiwan Chia-Yen Dai, Chung-Feng Huang, Wan-Long Chuang, Ming-Lung Yu Journal of the Formosan Medical Association.2025; 124: S113. CrossRef
Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis Hua Zhou, Mengxia Yan, Datian Che, Bin Wu JHEP Reports.2024; 6(4): 101000. CrossRef
Hepatitis C virus infection in patients undergoing surgery in a single tertiary academic center Jae Seung Lee, Hye Won Lee, Mi Na Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim Journal of Gastroenterology and Hepatology.2024; 39(6): 1155. CrossRef
Improving the hepatitis C virus care cascade with the in‐hospital Reflex tEsting ALarm‐C (REAL‐C) model Jonggi Choi, Jina Park, Won‐Mook Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young‐Suk Lim, Han Chu Lee, Sujin Kwon, Sang‐Hyun Hwang Liver International.2024; 44(5): 1243. CrossRef
A cost analysis of a simplified model for HCV screening and treatment at a tertiary hospital in Zimbabwe Blessing Dzingirai, Leolin Katsidzira, Vongai Mwanesani, Maarten Jacobus Postma, Marinus van Hulst, Nyashadzaishe Mafirakureva Expert Review of Pharmacoeconomics & Outcomes Research.2024; 24(5): 687. CrossRef
Contemporary Insights into Hepatitis C Virus: A Comprehensive Review Malik Sallam, Roaa Khalil Microorganisms.2024; 12(6): 1035. CrossRef
Prognosis Following Sustained Virologic Response in Korean Chronic Hepatitis C Patients Treated with Sofosbuvir-Based Treatment: Data from a Multicenter Prospective Observational Study up to 7 Years Yewan Park, Seong-Kyun Na, Jae-Hyun Yoon, Sung-Eun Kim, Ji-Won Park, Gi-Ae Kim, Hyo-Young Lee, Young-Sun Lee, Jeong-Han Kim Medicina.2024; 60(7): 1132. CrossRef
Correspondence to editorial on “Core indicators related to the elimination of hepatitis B and C virus infection in South Korea: A nationwide study” Chang Hun Lee, In Hee Kim, Sook-Hyang Jeong Clinical and Molecular Hepatology.2024; 30(4): 997. CrossRef
Response to antiviral therapy for chronic hepatitis C and risk of hepatocellular carcinoma occurrence in Japan: a systematic review and meta-analysis of observational studies Yoko Yamagiwa, Keitaro Tanaka, Keitaro Matsuo, Keiko Wada, Yingsong Lin, Yumi Sugawara, Tetsuya Mizoue, Norie Sawada, Hidemi Takimoto, Hidemi Ito, Tetsuhisa Kitamura, Ritsu Sakata, Takashi Kimura, Shiori Tanaka, Manami Inoue, Sarah Krull Abe, Shuhei Nomur Scientific Reports.2023;[Epub] CrossRef
Global burden of primary liver cancer and its association with underlying aetiologies, sociodemographic status, and sex differences from 1990–2019: A DALY-based analysis of the Global Burden of Disease 2019 study Sungchul Choi, Beom Kyung Kim, Dong Keon Yon, Seung Won Lee, Han Gyeol Lee, Ho Hyeok Chang, Seoyeon Park, Ai Koyanagi, Louis Jacob, Elena Dragioti, Joaquim Radua, Jae Il Shin, Seung Up Kim, Lee Smith Clinical and Molecular Hepatology.2023; 29(2): 433. CrossRef
Comorbidities and the use of comedications among patients with chronic hepatitis C in Korea: A nationwide cross-sectional study Kyung Min Kwon, Jae-Jun Shim, Gi-Ae Kim, Bo Ok Kim, Helin Han, Hyun Jung Ahn The Korean Journal of Internal Medicine.2023; 38(3): 338. CrossRef
Core indicators related to the elimination of hepatitis B and C virus infection in South Korea: A nationwide study Chang Hun Lee, Gwang Hyeon Choi, Hwa Young Choi, Sojung Han, Eun Sun Jang, Young Eun Chon, Young Chang, Kyung-Ah Kim, Do Young Kim, Hyung Joon Yim, Hye-Lin Kim, Sook-Hyang Jeong, In Hee Kim Clinical and Molecular Hepatology.2023; 29(3): 779. CrossRef
Real-life experience of ledipasvir and sofosbuvir for HCV infected Korean patients: a multicenter cohort study Soon Kyu Lee, Sung Won Lee, Hae Lim Lee, Hee Yeon Kim, Chang Wook Kim, Do Seon Song, U Im Chang, Jin Mo Yang, Sun Hong Yoo, Jung Hyun Kwon, Soon Woo Nam, Seok-Hwan Kim, Myeong Jun Song, Jaejun Lee, Hyun Yang, Si Hyun Bae, Ji Won Han, Heechul Nam, Pil Soo The Korean Journal of Internal Medicine.2022; 37(6): 1167. CrossRef
Finding Cases of Hepatitis C for Treatment Using Automated Screening in the Emergency Department is Effective, but What Is the Cost? David Stephen Prince, Julia Di Girolamo, Joseph Louis Pipicella, Melissa Bagatella, Tahrima Kayes, Frank Alvaro, Michael Maley, Hong Foo, Paul MacConachie Middleton, Miriam Tania Levy, Yu-Chen Fan Canadian Journal of Gastroenterology and Hepatology.2022; 2022: 1. CrossRef
How to Optimize the Care Cascade of Hepatitis C Virus Infection Beom Kyung Kim Gut and Liver.2022; 16(6): 809. CrossRef
First
Prev
