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Modelling the cost of eliminating hepatitis C virus transmission in Pakistan

Research output: Contribution to journalArticle

Original languageEnglish
JournalLancet Global Health
DateAccepted/In press - 6 Jan 2020

Abstract

Background: The World Health Organization (WHO) HCV-elimination strategy advocates scaling-up screening and treatment to reduce HCV incidence by 80% by 2030, but little is known about how this could be achieved and the costs of doing so. Methods: A general population HCV transmission, screening, and treatment model was calibrated with available data from Pakistan, incorporating cost data on diagnostics and HCV treatment. We modelled the impact and costs of alternative strategies for scaling-up screening and HCV treatment to determine what is needed and the resulting costs of achieving the WHO HCV incidence target in Pakistan. Findings: One-time screening of 90% of the 2018 population by 2030, with 80% referral to treatment, leads to 14 million individuals being screened and 350,000 treated annually, decreasing incidence by 27% over 2018-2030. Prioritising screening to higher prevalence groups (people who inject drugs (PWID) and adults >30 years) and introducing re-screening (annually for PWID, otherwise 10-yearly) increases the number screened and treated by half and decreases incidence by 51%. Decreasing HCV incidence by 80% requires doubling the primary screening rate, increasing referral to 90%, re-screening the general population every 5-years, and re-engaging those lost-to-follow-up every 5-years. This could cost USD$8 billion, reducing to USD$4 billion with lowest costs for diagnostic tests and drugs, including healthcare savings, and implementing a simplified treatment algorithm. Interpretation: Pakistan will need to invest up to 9% of their yearly health expenditure to enable sufficient scale-up in screening and treatment to achieve the WHO HCV-elimination target for incidence.

    Research areas

  • mathematical model, hepatitis C virus, direct-acting antiviral treatment, prevention, HCV elimination targets, incidence, mortality, screening, case-finding, Ab, RNA, diagnosis, cascade of care, cost-effectiveness, budget impact analysis

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