Cost-Effectiveness of Testing and Treatment for Hepatitis B Virus and Hepatitis C Virus Infections: An Analysis by Scenarios, Regions, and Income

David Tordrup¹, Yvan Hutin², Karin Stenberg³, Jeremy A Lauer⁴, David W Hutton⁵, Mehlika Toy⁶, Nick Scott⁷, Jagpreet Chhatwal⁸, Andrew Ball⁹

Affiliations

¹ WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands; World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland. Electronic address: dtordrup@gmail.com.
² World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland. Electronic address: hutiny@who.int.
³ World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland.
⁴ World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland; Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
⁵ University of Michigan School of Public Health, Ann Arbor, MI, USA.
⁶ Stanford University School of Medicine, Palo Alto, CA, USA.
⁷ Burnet Institute, Melbourne, Victoria, Australia.
⁸ Massachusetts, General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland; Division of Universal Health Coverage, Communicable and Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.

PMID: 33248510
PMCID: PMC7806510
DOI: 10.1016/j.jval.2020.06.015

Cost-Effectiveness of Testing and Treatment for Hepatitis B Virus and Hepatitis C Virus Infections: An Analysis by Scenarios, Regions, and Income

David Tordrup et al. Value Health. 2020 Dec.

. 2020 Dec;23(12):1552-1560.

doi: 10.1016/j.jval.2020.06.015. Epub 2020 Oct 9.

Authors

David Tordrup¹, Yvan Hutin², Karin Stenberg³, Jeremy A Lauer⁴, David W Hutton⁵, Mehlika Toy⁶, Nick Scott⁷, Jagpreet Chhatwal⁸, Andrew Ball⁹

Affiliations

¹ WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands; World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland. Electronic address: dtordrup@gmail.com.
² World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland. Electronic address: hutiny@who.int.
³ World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland.
⁴ World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland; Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
⁵ University of Michigan School of Public Health, Ann Arbor, MI, USA.
⁶ Stanford University School of Medicine, Palo Alto, CA, USA.
⁷ Burnet Institute, Melbourne, Victoria, Australia.
⁸ Massachusetts, General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland; Division of Universal Health Coverage, Communicable and Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.

PMID: 33248510
PMCID: PMC7806510
DOI: 10.1016/j.jval.2020.06.015

Abstract

Objectives: Testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are highly effective, high-impact interventions. This article aims to estimate the cost-effectiveness of scaling up these interventions by scenarios, regions, and income groups.

Methods: We modeled costs and impacts of hepatitis elimination in 67 low- and middle-income countries from 2016 to 2030. Costs included testing and treatment commodities, healthcare consultations, and future savings from cirrhosis and hepatocellular carcinomas averted. We modeled disease progression to estimate disability-adjusted life-years (DALYs) averted. We estimated incremental cost-effectiveness ratios (ICERs) by regions and World Bank income groups, according to 3 scenarios: flatline (status quo), progress (testing/treatment according to World Health Organization guidelines), and ambitious (elimination).

Results: Compared with no action, current levels of testing and treatment had an ICER of $807/DALY for HBV and -$62/DALY (cost-saving) for HCV. Scaling up to progress scenario, both interventions had ICERs less than the average gross domestic product/capita of countries (HBV: $532/DALY; HCV: $613/DALY). Scaling up from flatline to elimination led to higher ICERs across countries (HBV: $927/DALY; HCV: $2528/DALY, respectively) that remained lower than the average gross domestic product/capita. Sensitivity analysis indicated discount rates and commodity costs were main factors driving results.

Conclusions: Scaling up testing and treatment for HBV and HCV infection as per World Health Organization guidelines is a cost-effective intervention. Elimination leads to a much larger impact though ICERs are higher. Price reduction strategies are needed to achieve elimination given the substantial budget impact at current commodity prices.

Keywords: DALY; cost-effectiveness; elimination; viral hepatitis.

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