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Even though WHO has approved global goals for hepatitis elimination, most countries have yet to establish programs for hepatitis B and C, which account for 320 million infections and over a million deaths annually. One reason for this slow response is the paucity of robust, compelling analyses showing that national HBV/HCV programs could have a significant impact on these epidemics and save lives in a cost-effective, affordable manner. In this context, our team used an investment case approach to develop a national hepatitis action plan for South Africa, grounded in a process of intensive engagement of local stakeholders. Costs were estimated for each activity using an ingredients-based, bottom-up costing tool designed by the authors. The health impact and cost-effectiveness of the Action Plan were assessed by simulating its four priority interventions (HBV birth dose vaccination, PMTCT, HBV treatment and HCV treatment) using previously developed models calibrated to South Africa’s demographic and epidemic profile. The Action Plan is estimated to require ZAR3.8 billion (US$294 million) over 2017–2021, about 0.5% of projected government health spending. Treatment scale-up over the initial 5-year period would avert 13 000 HBV-related and 7000 HCV-related deaths. If scale up continues beyond 2021 in line with WHO goals, more than 670 000 new infections, 200 000 HBV-related deaths, and 30 000 HCV-related deaths could be averted. The incremental cost-effectiveness of the Action Plan is estimated at $3310 per DALY averted, less than the benchmark of half of per capita GDP. Our analysis suggests that the proposed scale-up can be accommodated within South Africa’s fiscal space and represents good use of scarce resources. Discussions are ongoing in South Africa on the allocation of budget to hepatitis. Our work illustrates the value and feasibility of using an investment case approach to assess the costs and relative priority of scaling up HBV/HCV services.

The achievement of goals for elimination of hepatitis B virus (HBV) and hepatitis C virus (HCV) requires broad access to HBV and HCV testing and treatment services. 1 In response to the coronavirus disease 2019 (COVID-19) pandemic, American Association for the Study of Liver Diseases (AASLD) and other liver associations recommended changes in hepatitis clinical care to mitigate transmission risks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. 2 In 2020, the Coalition for Global Hepatitis Elimination (CGHE) surveyed clinicians and program managers to assess the mitigation strategies deployed to reduce transmission and the changes in access to hepatitis testing and treatment services. MeTHODs A 53-question online survey was developed in SmartSheet by CGHE and partners,* translated into French and Spanish, and distributed via websites and e-mail. Responses were received between August 12, 2020, and December 16, 2020. Respondents were not required to answer all questions.

Backgrounds & Aims:In Indonesia 1.9 million people are chronically infected with hepatitis C virus (HCV), but a national strategic plan for elimination has not yet been developed, despite the availability of low-cost treatments which could save many lives. We used epidemiological and cost modelling to estimate targets and resource requirements of a national elimination program and explore the potential impact and cost-effectiveness. Methods: To model the HCV epidemic, we used a dynamic model, parameterised with Indonesia-specific data, accounting for disease progression, injecting drug use and demographics. Future scale-up scenarios were designed for 2018-2050 to capture possible policy choices. Costs of an initial 5-year national strategy and of long-term elimination were estimated for the most feasible scenario, as agreed with government and local partners. Cost savings from reduced drug and diagnostics prices were also estimated. The cost-effectiveness of baseline predictions and those with drug price reductions were compared to the no treatment scenario. Results: Elimination by 2045, considered the most feasible path to scale-up, would prevent 739 000 new infections and avert 158 000 HCV-related deaths. The costs would be $5.6 billion (USD) using baseline prices but could fall to $2.7 billion if price reductions for HCV drugs and diagnostics are secured. With these price reductions, the incremental cost-effectiveness ratio for a 2045 elimination program would be cost-effective at $300 (USD) per year of life saved vs the no treatment scenario. Conclusions:This study has underpinned advocacy efforts to secure Indonesian government commitment to HCV elimination, and provides further inputs for HCV strategic planning efforts. | 287TRICKEY ET al. | Scenario designTo understand the range of possible policy responses, we modelled treatment scale-up scenarios of varying elimination timeframes and scale-up intensity. The WHO definition for elimination is an 80% reduction in HCV incidence and a 65% reduction in HCV-related mortality from 2015 levels.

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