Abstract
BackgroundModelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.Methods and findingsWe adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare management to the economic productivity gains from reduced HCV-attributable absenteeism, presenteeism, and premature deaths. We also calculate the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for HCV elimination versus maintaining current levels of HCV treatment. This is compared to an opportunity cost-based willingness-to-pay threshold for Pakistan (US$148 to US$198/DALY).Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95% uncertainty interval (UI) 3.80 to 8.22) million DALYs and 333,000 (219,000 to 509,000) HCV-related deaths over 2018 to 2030. If HCV testing is partially integrated, this scale-up requires an investment of US$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV.ConclusionsInvestment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.
Highlights
Recent scientific advances in hepatitis C virus (HCV) treatment have made HCV elimination achievable [1,2,3,4,5,6], with cure rates above 90% [7] using direct-acting antiviral (DAA) medications
Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan
We considered different assumptions on DAA medication costs, discount rate, the cost of a productive life year lost (±20% of Pakistan’s GDP, or using median income), employment rate among people who inject drugs (PWID) or those with end-stage liver disease, reduction in absenteeism following sustained virological response (SVR) for pre-cirrhotic patients (44.0% reduction as with cirrhotic patients postSVR), no disutility prior to decompensated cirrhosis (DC), no healthcare management costs pre-cirrhosis, if less or greater integration were achieved, and if HCV elimination were to be achieved sooner
Summary
Recent scientific advances in hepatitis C virus (HCV) treatment have made HCV elimination achievable [1,2,3,4,5,6], with cure rates above 90% [7] using direct-acting antiviral (DAA) medications. Simple prevention strategies such as supplying clean needles and syringes within healthcare settings and to people who inject drugs (PWID) can prevent new infections [8,9]. Due to these advances, the World Health Organization (WHO) developed its Global Health Sector Strategy (GHSS) on Viral Hepatitis in 2016 [10], providing targets for eliminating HCV as a global public health problem, including reducing the annual incidence of new chronic infections by 80% and mortality by 65% by 2030 compared to 2015 levels. The economic benefits from integrating services or improving productivity were not included
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