Quantifying the non-medical costs patients incur to access hepatitis C treatment in Southern Vietnam

Background Hepatitis C virus (HCV) infection is a global public health concern, with an estimated 58 million people affected worldwide. Direct-acting antivirals (DAA) have revolutionized hepatitis C treatment. However, the cost of DAA treatment in many low- and middle-income countries remains a potential barrier to treatment access. Our study aimed to assess the non-medical costs associated with patients accessing DAA treatment in Vietnam and investigate potential disparities. Methods We conducted a patient-level micro-costing analysis based on 102 hepatitis C participants recruited from 2020 until 2021 at the Hospital for Tropical Diseases in Ho Chi Minh City (HCMC), Vietnam. We collected data on the direct non-medical costs and productivity costs incurred by the patients and their informal caregivers. Direct medical costs (such as the drug costs) were not included. The costs were considered from the patient/household perspective. Outputs were stratified based by the location of residence (within HCMC or not). Results We estimated that the mean total cost incurred by an outpatient for accessing a standard 12-week DAA treatment would be US$73.90 (US$24.63 per clinic visit). This cost was lower for those who lived in HCMC (US$33.49) and higher for those needing to travel from another southern province (US$107.01). The disparity between these two groups became greater when participants travelled with an informal caregiver. Productivity cost estimates varied significantly depending on the calculation method used and participant subgroup investigated, ranging between US$4.35–29.88 per visit. Conclusions Although modest compared with the total cost of DAA therapy, non-medical costs constitute a substantial share of household income for many patients, particularly those residing outside Ho Chi Minh City. Decentralising hepatitis C services could reduce travel and productivity losses, enhance affordability, and improve the equity and efficiency of treatment scale-up in Vietnam.