A global investment framework for hepatitis C elimination

Author: Alisa Pedrana, Jessica Howell, Nick Scott, Sophia Schroeder, Christian Kuschel, David Wilson, Jeffrey Lazarus, Ricardo Baptista Leite, Rifat Atun, Sharon Hutchinson, Margaret Hellard

Theme: Epidemiology & Public Health Research Year: 2019

Background: Direct-acting antivirals (DAAs) make it possible to eliminate hepatitis C as a public
health threat by 2030. However, investment in hepatitis C programs has been slow. One potential
explanation is the lack of a strategic approach to investment in prevention, testing and treatment
activities to achieve elimination. We proposed an investment framework to guide policymakers and
funders in making investment decisions that will enable hepatitis C elimination.
Methods: Our framework utilizes a public health approach to identify national activities aimed at
reducing hepatitis C transmission, morbidity, and mortality, and international activities necessary to
provide an enabling environment for countries to achieve maximum effectiveness. Key enablers
were highlighted including public support, community mobilization, and skilled workforces that can
facilitate the rapid scale-up of national activities. We also modelled the health and economic (direct
and indirect) benefits of scaling up hepatitis C elimination activities to meet the WHO global
elimination targets by 2030.
Results: Our models showed that investing to achieve elimination could reduce hepatitis C incidence
by 85% and hepatitis C-related mortality by 68% by 2030, preventing a cumulative 2.1 million
hepatitis C-related deaths and 12 million new hepatitis C infections. This required US $51 billion
globally between 2018-2030, peaking at US $5.7 billion in 2021 before becoming costsaving by 2027.
Overall, investing to achieve elimination produced a net US $19 billion return by 2030. Sharing
staffing costs already invested within the context of universal health coverage reduced the
cumulative costs of the elimination by $20.2 billion.
Conclusion: Investment in hepatitis C programs to achieve elimination can be both cost-effective
and becomes cost-saving by 2027. An investment case can help raise the profile of HCV elimination
and build political commitment to help mobilize domestic, private and international resources to
support countries to implement elimination programs.
Disclosure of Interest Statement:
The authors acknowledge funding support from Qatar Foundation to support this work and to
facilitate the WISH Viral Hepatitis Forum 2018. The Burnet also receives funding support from Gilead
Sciences Abbvie, GSK and Merck for investigator initiated research.

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