Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

Background Modelling 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 findings We 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. Conclusions Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.

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Hepatitis C elimination in Myanmar: Modelling the impact, cost, cost-effectiveness and economic benefits

The Lancet Regional Health - Western Pacific ◽

10.1016/j.lanwpc.2021.100129 ◽

2021 ◽

Vol 10 ◽

pp. 100129

Author(s):

Nick Scott ◽

Thin Mar Win ◽

Tom Tidhar ◽

Hla Htay ◽

Bridget Draper ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Economic Benefits ◽

The Impact ◽

Impact Cost

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The prevalence of hepatitis C virus (HCV) infection in HIV-positive individuals in the UK - trends in HCV testing and the impact of HCV on HIV treatment outcomes

Journal of Viral Hepatitis ◽

10.1111/j.1365-2893.2009.01215.x ◽

2009 ◽

Vol 17 (8) ◽

pp. 569-577 ◽

Cited By ~ 30

Author(s):

J. Turner ◽

L. Bansi ◽

R. Gilson ◽

B. Gazzard ◽

J. Walsh ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Treatment Outcomes ◽

Hiv Treatment ◽

Hcv Infection ◽

Hiv Positive ◽

Hiv Treatment Outcomes ◽

The Uk ◽

The Impact ◽

Hcv Testing

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The impact of timing and prioritization on the cost-effectiveness of birth cohort testing and treatment for hepatitis C virus in the United States

Hepatology ◽

10.1002/hep.26304 ◽

2013 ◽

Vol 58 (1) ◽

pp. 54-64 ◽

Cited By ~ 59

Author(s):

Phil McEwan ◽

Thomas Ward ◽

Yong Yuan ◽

Ray Kim ◽

Gilbert L'Italien

Keyword(s):

United States ◽

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Birth Cohort ◽

The United States ◽

The Cost ◽

The Impact

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Cost-effectiveness and Budgetary Impact of Hepatitis C Virus Testing, Treatment, and Linkage to Care in US Prisons

Clinical Infectious Diseases ◽

10.1093/cid/ciz383 ◽

2019 ◽

Vol 70 (7) ◽

pp. 1388-1396 ◽

Cited By ~ 5

Author(s):

Sabrina A Assoumou ◽

Abriana Tasillo ◽

Claudia Vellozzi ◽

Golnaz Eftekhari Yazdi ◽

Jianing Wang ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Liver Fibrosis ◽

Linkage To Care ◽

Cost Effective ◽

Budgetary Impact ◽

Current Drug ◽

Drug Prices ◽

Hcv Testing

Abstract Background Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (US) prisons or linkage to care at release. Methods We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a US prison cohort at entry using published data and Washington State DOC individual-level data. We considered permutations of testing (risk factor based, routine at entry or at release, no testing), treatment (if liver fibrosis stage ≥F3, for all HCV infected or no treatment), and linkage to care (at release or no linkage). Outcomes included quality-adjusted life-years (QALY); cases identified, treated, and cured; cirrhosis cases avoided; incremental cost-effectiveness ratios; DOC costs (2016 US dollars); and BI (healthcare cost/prison entrant) to generalize to other states. Results Compared to “no testing, no treatment, and no linkage to care,” the “test all, treat all, and linkage to care at release” model increased the lifetime sustained virologic response by 23%, reduced cirrhosis cases by 54% at a DOC annual additional cost of $1440 per prison entrant, and would be cost-effective. At current drug prices, targeted testing and liver fibrosis–based treatment provided worse outcomes at higher cost or worse outcomes at higher cost per QALY gained. In sensitivity analysis, fibrosis-based treatment restrictions were cost-effective at previous higher drug costs. Conclusions Although costly, widespread testing and treatment in prisons is considered to be of good value at current drug prices.

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Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs

Addiction ◽

10.1111/add.12754 ◽

2014 ◽

Vol 110 (1) ◽

pp. 129-143 ◽

Cited By ~ 29

Author(s):

Bruce R. Schackman ◽

Jared A. Leff ◽

Devra M. Barter ◽

Madeline A. DiLorenzo ◽

Daniel J. Feaster ◽

...

Keyword(s):

Substance Abuse ◽

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Substance Abuse Treatment ◽

Hiv Testing ◽

Treatment Programs ◽

Abuse Treatment ◽

Hcv Testing

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Modelling the Impact and Cost-effectiveness of Extended Hepatitis C Virus Screening and Treatment with Direct-acting Antivirals in a Swiss Custodial Setting

Clinical Infectious Diseases ◽

10.1093/cid/ciz088 ◽

2019 ◽

Vol 69 (11) ◽

pp. 1980-1986 ◽

Cited By ~ 4

Author(s):

François Girardin ◽

Natalie Hearmon ◽

Erika Castro ◽

Francesco Negro ◽

Lucy Eddowes ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Cost Effective ◽

Screening Strategy ◽

Standard Test ◽

Current Approach ◽

Subsequent Treatment ◽

Base Case ◽

The Impact

Abstract Background Hepatitis C virus (HCV) among people living in detention (PLD) is typically high in many countries including Switzerland, where it is estimated that the HCV prevalence rate is between 5.7% and 6.2%. In Switzerland, the existing screening strategy involves routine screening of PLD who indicate they are from HCV high-risk populations based on questionnaire responses upon entry to the detention center, rather than an offer to screen all PLD. Methods A cost-effectiveness analysis from a Swiss healthcare provider perspective was conducted by combining a 5-year decision tree screening model with results from a Markov model of HCV treatment outcomes. This model explored the cost-effectiveness of increased HCV screening to cover all PLD compared to the current approach, using a standard test package and subsequent treatment with a single-tablet regimen in Swiss custodial settings. Sensitivity and scenario analyses examined the uncertainty of results. Results At the willingness-to-pay threshold of 100 000 Swiss Francs (CHF) per quality-adjusted life-year (QALY), comprehensive general screening was cost-effective compared to current risk-based screening, with a base case incremental cost-effectiveness ratio of CHF 14 312 per QALY. The net monetary benefit of screening the whole PLD population was CHF 23 298 046 and CHF 4298 per person. The proportion of PLD tested was predicted to increase from 13.6% to 67.0% under comprehensive screening. Conclusion The results showed that comprehensive screening strategies in detention centers in Switzerland can be cost-effective, with the probabilistic sensitivity analysis estimating an 82.3% probability of cost-effectiveness.

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