CAPE TOWN – South Africa’s five-year National Hepatitis Action Plan has been highlighted as one of the first examples of an investment case that combines tools for costing, impact modelling, cost-effectiveness analysis, and fiscal space analysis for scaled-up Hepatitis B and C (HBV/HCV) disease control scenarios.
This is contained in a report by PubMed Central (PMC) – a full-text archive of biomedical and life sciences journal literature – which stated that HBV and HCV had significant burdens globally and nationally, accounting for more than 300 million infections and more than 1 million deaths annually worldwide.
Despite the advent of new cures for HCV, according to the report, an expanding array of prevention and treatment options for HBV, and the adoption of ambitious global HBV and HCV targets, few countries have designed or embarked on programme scale-up to date.
South Africa’s five-year National Hepatitis Action Plan is one of the first examples of an investment case that combines tools for costing, impact modelling, cost-effectiveness analysis, and fiscal space analysis for scaled-up HBV and HCV disease control scenarios.
The Action Plan investment case shows that carefully selected investments in HBV and HCV can have a significant impact on the twin epidemics, while meeting standard cost-effectiveness criteria and demonstrating affordability amid government expenditure constraints.
Even though the World Health Organisation (WHO) has approved global goals for hepatitis elimination, most countries are yet to establish programmes for Hepatitis B and C.
The report states that one reason for this slow response is the paucity of robust, compelling analyses showing that national HBV/HCV programmes 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.
“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,” reads the report.
The Action Plan was estimated to require about R3.8 billion over 2017–2021, about 0.5 percent of projected government health spending. Treatment scale-up over the initial five-year period would avert 13 000 HBV-related and 7 000 HCV-related deaths.
The report states that if scale up continued 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.
“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,” reads the report.
The investment case approach used in South Africa can be adapted to other contexts and can guide other countries looking to synthesize and analyse the evidence needed to consider the advisability of embarking on large scale investments in HBV/HCV.
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