Theme: Epidemiology & Public Health Research Year: 2019
Background: Major gains in reducing the burden of hepatitis C are now possible due to
advancements in diagnostics and the discovery of a cure. The prevention of premature deaths and
increased workforce participation among people who are cured are likely to provide significant
indirect economic benefits. To help catalyze financing, we developed a global investment case for
hepatitis C, for the first time considering both direct and indirect economic benefits.
Methods: Mathematical and economic modelling was used to estimate the impact, cost, costeffectiveness and return on investment of hepatitis C elimination, involving scaling up testing and
treatment to reach the WHO targets of 90% of people living with hepatitis C diagnosed and 80% of
people diagnosed started on treatment by 2030. Independent epidemic models were calibrated for
the six WHO world regions, and a productivity model was used to capture hepatitis C-attributable
productivity losses due to absenteeism and presenteeism.
Results: Investment in hepatitis C testing and treatment to achieve elimination was estimated to
cost US$51.0 (US$42.1-60.0) billion globally between 2018 and 2030, requiring a peak in annual
investment of US$5.7 (US$4.8-6.6) billion in 2021, before the annual direct costs became less than a
scenario of inaction by 2030. In the models, this investment became cost-saving by 2027 due to
substantive productivity gains, and produced a net US$19.4 (US$4.4-33.1) billion return by 2030 in
addition to preventing 2.1 (1.2-3.1) million hepatitis C-related deaths and 12 (9-19) million new
hepatitis C infections between 2018 and 2030. A scenario to achieve only 45% of people with
hepatitis C diagnosed was also cost-saving by 2027, but resulted in significantly lower longer-term
returns (US$7.2 [US$3.5-14.9] billion by 2030), due to ongoing transmission leading to perpetual
treatment costs.
Conclusion: Countries should consider hepatitis C investment cases to support early financing for
greater long-term returns.
Disclosure of Interest Statement: NS receives investigator-initiated research funding from Gilead
Sciences unrelated to this work. AT is an advisory board member for Gilead Sciences, AbbVie, BMS,
Merck and Roche Diagnostics, and a speaker for Gilead, Merck, BMS, AbbVie, Roche Diagnostics. MH
and the Burnet Institute receive investigator-initiated research funding from Gilead Sciences, AbbVie
and BMS.