Economic Analysis of National Program for Hepatitis C Elimination, Israel, 20231

Abstract

In 2021, the Israel Ministry of Health began a national hepatitis C elimination program. Implementing a World Health Organization goal, Israel's program involved targeted screening, barrier minimization, workup simplification, awareness campaigns, and a patient registry. We evaluated program costs for testing and treatment. By May 15, 2023, the program had identified 865,382 at-risk persons, of whom 555,083 (64.3%) were serologically screened for hepatitis C virus (HCV), which was detected in 24,361 (4.4%). Among 20,928 serologically positive patients, viremia was detected in 13,379 (63.9%), of whom 10,711 (80%) were treated, and 4,618 (96.5%) of 4,786 persons receiving posttreatment HCV RNA testing had sustained virologic response. We estimated costs of ₪14,426 (new Israel shekel; ≈$3,606 USD) per person whose HCV infection was diagnosed and successfully treated. The program yielded screening and treatment in almost two thirds of the identified at-risk population. Although not eliminated, HCV prevalence will likely decrease substantially by the 2030 target.

Keywords: Hepatitis C; Israel; cost estimation; elimination program; viruses.

Figure 1

Geographic mapping in an economic analysis of a national program for hepatitis C elimination, Israel, 2023. Screenshot show Hebrew-language mapping by Points Location Intelligence company (https://points.co.il) in ArcGIS (www.arcgis.com). Upper right inset shows clinic locations (orange dots) at the beginning of the program. Blue shading indicates areas with higher populations of immigrants from the former Soviet Union, who are at higher risk for hepatitis C virus infection; intensity of shading increases as population numbers rise. Detail on left shows increased clinical sites added as part of the hepatitis C elimination program. Each colored dot (orange, blue, green, purple) represents a clinic and its affiliation to 1 of the 4 health maintenance organizations, shaded areas that represent the prevalence of population at risk in a given geographic area. Darker blue indicates higher concentrations of at-risk populations. Combining the 2 parameters (clinics distribution and density of population at risk density) enabled a systematic strategy for a targeted approach to identify and list clinics for higher yield in program accomplishment.

Figure 2

Flowchart of participant enrollment, virologic screening, and HCV treatment in an economic analysis of a national program for hepatitis C elimination, Israel, 2023. HCV, hepatitis C virus.

Figure 3

Assessment of patients treated in 4 HMOs in an economic analysis of a national program for hepatitis C elimination, Israel, 2023. Scales for the y-axes differ substantially to underscore patterns but do not permit direct comparisons. HMO, health maintenance organization.