Abstract
The World Health Assembly calls for elimination of viral hepatitis as a public health threat by 2030 (ie, -90% incidence and -65% mortality). However, WHO's 2017 cost projections to achieve health-related Sustainable Development Goals did not include the resources needed for hepatitis testing and treatment. We aimed to estimate the incremental commodity cost of adding scaled up interventions for testing and treatment of hepatitis to WHO's investment scenarios. We added modelled costs for implementing WHO recommended hepatitis testing and treatment to the 2017 WHO cost projections. We quantified additional requirements for diagnostic tests, medicines, health workers' time, and programme support across 67 low-income and middle-income countries, from 2016-30. A progress scenario scaled up interventions and a more ambitious scenario was modelled to reach elimination by 2030. We used 2018 best available prices of diagnostics and generic medicines. We estimated total costs and the additional investment needed over the projection of the 2016 baseline cost. The 67 countries considered included 230 million people living with hepatitis B virus (HBV) and 52 million people living with hepatitis C virus (HCV; 90% and 73% of the world's total, respectively). Under the progress scenario, 3250 million people (2400 million for HBV and 850 million for HCV) would be tested and 58·2 million people (24·1 million for HBV and 34·1 million for HCV) would be treated (total additional cost US$ 27·1 billion). Under the ambitious scenario, 11 631 million people (5502 million for HBV and 6129 million for HCV) would be tested and 93·8 million people (32·2 million for HBV and 61·6 million for HCV) would be treated (total additional cost $58·7 billion), averting 4·5 million premature deaths and leading to a gain of 51·5 million healthy life-years by 2030. However, if affordable HCV medicines remained inaccessible in 13 countries where medicine patents are protected, the additional cost of the ambitious scenario would increase to $118 billion. Hepatitis elimination would account for a 1·5% increase to the WHO ambitious health-care strengthening scenario costs, avert an additional 4·6% premature deaths, and add an additional 9·6% healthy life-years from 2016-30. Access to affordable medicines in all countries will be key to reach hepatitis elimination. This study suggests that elimination is feasible in the context of universal health coverage. It points to commodities as key determinants for the overall price tag and to options for cost reduction strategies. WHO, United States Centers for Disease Control and Prevention, Unitaid.
Highlights
In 2015, viral hepatitis led to 1·34 million deaths globally.[1]
Scenarios considered We extended the methods used for WHO’s Sustainable Development Goals (SDGs) investment model, in the same 67 countries to add testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection.[13]
The third ambitious elimination scenario consisted of a scaling up that would reach the coverage required to achieve HBV and HCV elimination.[2]
Summary
In 2015, viral hepatitis led to 1·34 million deaths globally.[1]. Most viral hepatitis deaths are secondary to cirrhosis and hepatocellular carcinoma, which can be prevented with testing and treatment. In 2016, the World Health Assembly adopted elimination of viral hepatitis as a public health threat by 2030 (–90% incidence, –65% mortality).[2] Modelling work indicated that elimination could be achieved by reaching sufficient coverage for five core interventions.[3,4] These WHO recommended interventions are infant immunisation against hepatitis B,5 prevention of mother-to-child transmission of hepatitis B virus (HBV) through timely hepatitis B birth dose vaccination and other approaches,[5] blood[6] and injection safety,[7] harm reduction for people who inject drugs,[8] and HBV and hepatitis C virus (HCV) testing[9] and treatment.[10,11] In 2016, preliminary cost estimates of viral hepatitis elimination were done by use of a programme-centred approach.[4] not all countries had been included www.thelancet.com/lancetgh Vol 7 September 2019
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
