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. 2021 Mar;74(3):535-549.
doi: 10.1016/j.jhep.2020.09.013. Epub 2020 Sep 22.

A global investment framework for the elimination of hepatitis B

Jessica Howell  1 , Alisa Pedrana  2 , Sophia E Schroeder  2 , Nick Scott  2 , Lisa Aufegger  3 , Rifat Atun  4 , Ricardo Baptista-Leite  5 , Gottfried Hirnschall  6 , Ellen 't Hoen  7 , Sharon J Hutchinson  8 , Jeffrey V Lazarus  9 , Lesi Olufunmilayo  10 , Raquel Peck  11 , Manik Sharma  12 , Annette H Sohn  13 , Alexander Thompson  14 , Mark Thursz  15 , David Wilson  2 , Margaret Hellard  16
Affiliations

A global investment framework for the elimination of hepatitis B

Jessica Howell et al. J Hepatol. 2021 Mar.

Abstract

Background & aims: More than 292 million people are living with hepatitis B worldwide and are at risk of death from cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals.

Methods: To catalyse political commitment and to encourage domestic and international financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination.

Results: The framework utilises a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from their investments - in the context of the WHO's 2030 viral elimination targets.

Conclusion: Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost saving by 2030.

Lay summary: Hepatitis B infection is a major cause of death from liver disease and liver cancer globally. To reduce deaths from hepatitis B infection, we need more people to be tested and treated for hepatitis B. In this paper, we outline a framework of activities to reduce hepatitis B-related deaths and discuss ways in which governments could pay for them.

Keywords: Cost-effectiveness; Disease elimination; Health financing; Hepatitis B; Universal health coverage; Viral hepatitis.

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Conflict of interest statement

Conflict of interest JH has received investigator-initiated funding and speaker fees from Gilead Sciences. AHS reports grants to her institution from ViiV Healthcare. ETH is the former director of the Medicines Patent Pool. NS has received investigator-initiated research funding from Gilead Sciences. AP has received investigator-initiated research funding from Gilead Sciences, MSD and AbbVie, and honoraria from Gilead Sciences. JVL reports grants and personal fees from AbbVie, Gilead Sciences and MSD, personal fees from CEPHEID and Janssen, all outside the submitted work. MS is principal investigator in an investigator-initiated trial sponsored by Gilead Sciences (received no PI fees, trial closed April 17th 2019) and reports an educational grant to travel to EASL 2019 (Gilead Sciences). SJH received honoraria from Gilead, unrelated to submitted work. AJT is advisory board member for Gilead Sciences, Arbutus Biopharma, AbbVie, BMS, Bayer, Roche, Ipsen, Eisai, Immunocore Ltd, Clear B Therapeutics, ViR therapeutics and has received speaker fees and investigator-initiated funding from Gilead Sciences, AbbVie and BMS. MH's Institute receives investigator initiated research funding from Gilead Sciences, Abbvie and BMS. JH received the Gilead Sciences Australia fellowship (2017). DW, CK, RA, RBL, MB, LA, AG, SH, RH, WL, RBM, SO, RP, MS, CWS, MT, ESS have nothing to declare. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

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Graphical abstract
Fig. 1
Fig. 1
Proposed Investment framework for hepatitis B and hepatitis C elimination. (Source: Pedrana A, Howell J, Scott N, et al. Global hepatitis C elimination: an investment case. Lancet Gastroenterology and Hepatology 202020). (This figure appears in color on the web.)
Fig. 2
Fig. 2
Hepatitis B elimination activities and disease impact by different levels of investment. Countries can make important gains towards achieving hepatitis B elimination with various levels of investment, however the greatest impact on burden of disease and therefore the greatest returns on investment are achieved with investment in an elimination strategy.
See this image and copyright information in PMC

References

    1. Polaris Observatory CDA Foundation Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018;3(6):383–403. - PubMed
    1. World Health Organisation Global Hepatitis Report 2017. 2017. http://appswhoint/iris/bitstream/handle/10665/255016/9789241565455-engpd... Available at:
    1. Stanaway J.D., Flaxman A.D., Naghavi M., Fitzmaurice C., Vos T., Abubakar I., et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388(10049):1081–1088. - PMC - PubMed
    1. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57(1):167–185. - PubMed
    1. WHO Global Policy Report on the Prevention and Control of Viral Hepatitis. 2012. http://wwwwhoint/csr/disease/hepatitis/global_report/en/ Available at:

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