Viral hepatitis is estimated to be responsible for 1.45 million deaths annually from liver failure and cancer. The majority of these deaths are now entirely preventable through hepatitis B (HBV) vaccinations and a new breakthrough class of cures for hepatitis C (HCV).
Despite the fact that the inexpensive HBV vaccine is widely available and inexpensive treatment is possible using AIDS drugs, and even though recent generic licensing agreements are driving down the price of HCV cures, these life-saving interventions are still not yet accessible in many developing countries. Incomplete vaccination coverage for HBV still results from the transfer of infected mothers to children during birth and from hospital workers to patients. For HCV, additional non-price barriers include lack of awareness of the scale of HCV prevalence and the absence of robust costed and resourced national scale-up plans and investment cases.
THE PHAROS SOLUTION
Pharos is using its expertise to assist ministries of finance and health in planning how to invest in hepatitis prevention and treatment. Pharos is providing technical assistance to country governments to estimate costs, develop strategies and national action plans, analyze the trade-offs among different options for scale-up, and develop strong investment cases for investment in HBV and HCV treatment based on impact and benefit-cost analysis. By generating detailed estimates of the costs of HBV and HCV prevention and treatment, countries will know how much funding they will need to mobilize to fight chronic hepatitis and why it is worth it in terms of the lives saved and health costs averted. Robust investment cases that consider the full range of health, financial, and economic benefits from HBV and HCV elimination will strengthen the health sector’s ability to negotiate increased financial support from national treasuries and other domestic and external funders.
Because hepatitis prevention and treatment scale-up is a new and burgeoning area in global health, Pharos has made it a priority to invest in and cultivate the development of improved modelling and analytical tools for hepatitis policy planning. Our tools are designed to contribute to an “investment case” for hepatitis scale-up. For example, Pharos has developed a unique, activity-based costing tool that facilitates the detailed costing of national strategic plans. For disease and impact modelling to demonstrate the public health impact of national hepatitis programs, Pharos partners with leading universities and institutions. For HBV, we have collaborated with Imperial College London. For HCV, we have worked with the Center for Disease Analysis (CDA), University of Bristol, and Imperial College London. For costing and economic modelling, we partner with local consultants, experienced experts, and leading academic thought-leaders, such as Professors Stephen Resch and Miloud Kaddar to complement Pharos’s own core strengths.
Our full investment case toolkit includes:
- Defining policy options
- Epidemiological modeling
- Short-term and long-term costing
- Cost-effectiveness analysis
- Return on investment analysis
- Budget impact analysis
- Resource gap estimations
- Development of resource mobilization plans
- Qualitative policy analysis
We anticipate that the approaches and findings generated — from the costed scale-up plans, financing options, and investment cases — can be transferred and adapted to other low- and middle-income countries working to eliminate hepatitis C and control hepatitis B. We will continue offering technical support to countries wishing to estimate the resource needs, model projected impact, and develop investment cases for hepatitis treatment scale-up. We also will support the development of the next generation of hepatitis planning and modelling tools, looking for ways to improve their dynamic abilities and comprehensibility. We continue to identify cross-cutting lessons and best practices through our experiences across countries and the use of in-depth approaches and methodologies. We hope that further dissemination of these lessons and practices will continue to support increased access to lifesaving treatment and cures.