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. 2019 May-Jun;23(3):182-190.
doi: 10.1016/j.bjid.2019.04.010. Epub 2019 May 27.

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach

Adele Schwartz Benzaken  1 , Renato Girade  2 , Elisa Catapan  2 , Gerson Fernando Mendes Pereira  2 , Elton Carlos de Almeida  2 , Simone Vivaldini  2 , Neide Fernandes  2 , Homie Razavi  3 , Jonathan Schmelzer  3 , Maria Lucia Ferraz  4 , Paulo Roberto Abrão Ferreira  5 , Mario Guimarães Pessoa  6 , Ana Martinelli  7 , Francisco José Dutra Souto  8 , Nick Walsh  9 , Maria Cassia Mendes-Correa  10
Affiliations

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach

Adele Schwartz Benzaken et al. Braz J Infect Dis. 2019 May-Jun.

Abstract

Introduction and aim: Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO).

Methods: A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024.

Results: An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025-2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality.

Conclusion: Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers.

Keywords: Brazil; Hepatitis C; Hepatitis C disease burden; Hepatitis C elimination.

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Figures

Fig. 1
Fig. 1
The HCV disease progression in the Markov model.
Fig. 2
Fig. 2
Hepatitis C prevalence by age and sex.
Fig. 3
Fig. 3
Direct costs in the NSP scenario and the base case scenarios.
Fig. 4
Fig. 4
Indirect costs in the NSP scenario and the base case scenarios.
Fig. 5
Fig. 5
Comparing direct and indirect costs in the NSP and base scenarios.
Fig. 6
Fig. 6
Comparing public health budget utilization in the NSP scenario with the base case scenario.
See this image and copyright information in PMC

References

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