Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.

<h4>Background</h4>Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.<h4>M...

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Autores principales:	Aaron G Lim, Nick Scott, Josephine G Walker, Saeed Hamid, Margaret Hellard, Peter Vickerman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/89a2afa21ed443139bcab08f9e97482f
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spelling	oai:doaj.org-article:89a2afa21ed443139bcab08f9e97482f2021-11-25T05:37:41ZHealth and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.1549-12771549-167610.1371/journal.pmed.1003818https://doaj.org/article/89a2afa21ed443139bcab08f9e97482f2021-10-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003818https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.<h4>Methods and findings</h4>We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare management to the economic productivity gains from reduced HCV-attributable absenteeism, presenteeism, and premature deaths. We also calculate the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for HCV elimination versus maintaining current levels of HCV treatment. This is compared to an opportunity cost-based willingness-to-pay threshold for Pakistan (US$148 to US$198/DALY). Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95% uncertainty interval (UI) 3.80 to 8.22) million DALYs and 333,000 (219,000 to 509,000) HCV-related deaths over 2018 to 2030. If HCV testing is partially integrated, this scale-up requires an investment of US$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV.<h4>Conclusions</h4>Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.Aaron G LimNick ScottJosephine G WalkerSaeed HamidMargaret HellardPeter VickermanPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 10, p e1003818 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Aaron G Lim Nick Scott Josephine G Walker Saeed Hamid Margaret Hellard Peter Vickerman Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.
description	<h4>Background</h4>Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.<h4>Methods and findings</h4>We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare management to the economic productivity gains from reduced HCV-attributable absenteeism, presenteeism, and premature deaths. We also calculate the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for HCV elimination versus maintaining current levels of HCV treatment. This is compared to an opportunity cost-based willingness-to-pay threshold for Pakistan (US$148 to US$198/DALY). Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95% uncertainty interval (UI) 3.80 to 8.22) million DALYs and 333,000 (219,000 to 509,000) HCV-related deaths over 2018 to 2030. If HCV testing is partially integrated, this scale-up requires an investment of US$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV.<h4>Conclusions</h4>Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.
format	article
author	Aaron G Lim Nick Scott Josephine G Walker Saeed Hamid Margaret Hellard Peter Vickerman
author_facet	Aaron G Lim Nick Scott Josephine G Walker Saeed Hamid Margaret Hellard Peter Vickerman
author_sort	Aaron G Lim
title	Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.
title_short	Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.
title_full	Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.
title_fullStr	Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.
title_full_unstemmed	Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.
title_sort	health and economic benefits of achieving hepatitis c virus elimination in pakistan: a modelling study and economic analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/89a2afa21ed443139bcab08f9e97482f
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Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis.

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