Abstract
Background and Aims:
In 2024, < 10% of hepatitis C virus (HCV) cases were treated in Eastern Europe and Central Asia (EECA) and the burden remains high. We aimed to estimate the cost-effectiveness of treating anyone with HCV (‘treat all’) or targeting people who inject drugs (PWID) in 14 middle-income EECA countries.
Methods:
We gathered costs of screening, confirmatory tests, direct-acting antiviral (DAA) treatment and monitoring from published country-specific data, Georgian costs from previous analyses, and UNICEF. We combined decision tree modelling with a dynamic transmission model of HCV calibrated for each EECA country to calculate quality-adjusted life years (QALYs) gained by 2030 from 100 DAA treatments in 2024, for treat all compared to targeting PWID. We calculated incremental cost-effectiveness ratios (ICERs, cost per QALY gained) relative to gross domestic product (GDP) per capita.
Results:
QALYs gained from 100 treatments ranged from 29-55 if treat all and 25–90 if targeting PWID. Using country-level costs, Bulgaria and Russia had ICERs above GDP per capita due to high DAA costs. For other countries, ICERs ranged from 18% to 89% of GDP (treat all) and 4%–89% (PWID). Using lower Georgian costs and UNICEF costs, the treat all ICERs were below 84% and 24% of GDP for all countries, respectively, except Bosnia, while the ICERs when targeting PWID were below 64% and 16% of GDP, respectively.
Conclusions:
Strategies that treat all persons with HCV and target PWID are both likely to be cost-effective in middle-income EECA countries, particularly with broad access to low-cost generic treatments such as through UNICEF procurement.
In 2024, < 10% of hepatitis C virus (HCV) cases were treated in Eastern Europe and Central Asia (EECA) and the burden remains high. We aimed to estimate the cost-effectiveness of treating anyone with HCV (‘treat all’) or targeting people who inject drugs (PWID) in 14 middle-income EECA countries.
Methods:
We gathered costs of screening, confirmatory tests, direct-acting antiviral (DAA) treatment and monitoring from published country-specific data, Georgian costs from previous analyses, and UNICEF. We combined decision tree modelling with a dynamic transmission model of HCV calibrated for each EECA country to calculate quality-adjusted life years (QALYs) gained by 2030 from 100 DAA treatments in 2024, for treat all compared to targeting PWID. We calculated incremental cost-effectiveness ratios (ICERs, cost per QALY gained) relative to gross domestic product (GDP) per capita.
Results:
QALYs gained from 100 treatments ranged from 29-55 if treat all and 25–90 if targeting PWID. Using country-level costs, Bulgaria and Russia had ICERs above GDP per capita due to high DAA costs. For other countries, ICERs ranged from 18% to 89% of GDP (treat all) and 4%–89% (PWID). Using lower Georgian costs and UNICEF costs, the treat all ICERs were below 84% and 24% of GDP for all countries, respectively, except Bosnia, while the ICERs when targeting PWID were below 64% and 16% of GDP, respectively.
Conclusions:
Strategies that treat all persons with HCV and target PWID are both likely to be cost-effective in middle-income EECA countries, particularly with broad access to low-cost generic treatments such as through UNICEF procurement.
| Original language | English |
|---|---|
| Article number | e70199 |
| Number of pages | 13 |
| Journal | Liver International |
| Volume | 45 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 2 Jul 2025 |
Bibliographical note
Publisher Copyright:© 2025 The Author(s). Liver International published by John Wiley & Sons Ltd.
Research Groups and Themes
- HEHP@Bristol
- GEM-B
