Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study

Abstract

Background/aims: The World Health Organization set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination.

Methods: Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022-2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths.

Results: The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022-2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868).

Conclusion: Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost-effective.

Keywords: China; Cost-effectiveness analysis; Disease eradication; Hepatitis C; Outcome assessment, health care.

Figure 1.

Cost-effectiveness frontiers of 12 strategies that could achieve hepatitis C elimination targets. The solid line is the cost-effectiveness frontier, strategies above the frontier are dominated by strategies on the frontier. DALY, disability-adjusted life year; GDP, gross domestic product.

Figure 2.

One-way sensitivity analyses for the P14-R4-T95 strategy vs. status quo strategy. ICER, incremental cost-effectiveness ratio; DALY, disability-adjusted life year; TP, transition probability; DAAs, direct antiviral agents; F0–F3, liver fibrosis stages; F4, compensated cirrhosis; DC, decompensated cirrhosis; HCC, hepatocellular carcinoma.

Figure 3.

Cost-effectiveness acceptability curves for the four strategies on the cost-effectiveness frontier. DALY, disability-adjusted life year.