Pharos Global Health Advisors, Boston, MA, USA.
Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Health Policy Plan. 2018 May 1;33(4):528-538. doi: 10.1093/heapol/czy018.
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.
尽管世界卫生组织已经批准了全球消除肝炎的目标，但大多数国家尚未建立乙型肝炎和丙型肝炎计划，而这两种肝炎每年导致 3.2 亿人感染，100 多万人死亡。对此反应迟缓的一个原因是缺乏强有力的、令人信服的分析，这些分析表明，国家乙型肝炎/丙型肝炎方案可以对这些传染病产生重大影响，并以具有成本效益且负担得起的方式挽救生命。在这种情况下，我们的团队使用投资案例方法为南非制定了国家肝炎行动计划，该计划基于对当地利益相关者的深入参与过程。使用作者设计的基于成分的自下而上的成本核算工具，为每项活动估算成本。通过模拟该行动计划的四项优先干预措施（乙型肝炎疫苗接种、预防母婴传播、乙型肝炎治疗和丙型肝炎治疗），评估该行动计划的健康影响和成本效益，这些模型是根据南非的人口和流行病学特征进行校准的。该行动计划估计在 2017-2021 年期间需要 38 亿南非兰特（2.94 亿美元），约占政府卫生支出的 0.5%。在最初的 5 年期间扩大治疗规模将避免 13000 例乙型肝炎相关死亡和 7000 例丙型肝炎相关死亡。如果按照世界卫生组织的目标在 2021 年之后继续扩大规模，可避免超过 67 万例新感染、20 万例乙型肝炎相关死亡和 3 万例丙型肝炎相关死亡。该行动计划的增量成本效益估计为每例伤残调整生命年节省 3310 美元，低于人均国内生产总值的一半这一基准。我们的分析表明，拟议的扩大规模可以在南非的财政空间内得到容纳，并且是对稀缺资源的良好利用。南非正在就肝炎预算分配进行讨论。我们的工作说明了使用投资案例方法评估乙型肝炎/丙型肝炎服务扩大规模的成本和相对优先次序的价值和可行性。
