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. For HBV, incomplete vaccination coverage still results from 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.
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, analyse 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 HBV 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. Pharos has developed a unique, activity-based costing tool that facilitates the detailed costing of national strategic plans. For disease and impact modelling, 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 local consultants, experienced experts, and leading academic thought-leaders, such as Professors Stephen Resch and Miloud Kaddar to complement Pharos’s own core strengths.
Since mid-2016, Pharos has been working closely with South Africa’s National Department of Health (NDOH) and local clinicians as they develop their national viral hepatitis prevention and treatment guidelines and five-year strategic plan for both HBV and HCV. In particular, Pharos has been focused on the translation of these documents into a 5-year Action Plan. We developed the Action Plan using an investment case framework where we synthesized detailed costing, projected impact, cost-effectiveness analysis, and financing and budget impact analysis into a cohesive narrative that makes the case for why hepatitis investments would be affordable and reduce a significant burden of disease in South Africa. Pharos continues to support South Africa to make evidence-based decisions regarding hepatitis policy-making and programming, and to secure additional funding for launching a national hepatitis program in South Africa.
In early 2017, Pharos met with leading Malaysian hepatologists and Ministry of Health officials to discuss how we could best support HCV scale-up ambitions in Malaysia. It was agreed that Pharos’ technical support would be most needed in modeling cost-effective screening strategies that would enable national treatment scale-up. Through continued deep collaboration with the University of Malaya and the Netherlands Institute for Health and the Environment, Pharos is estimating screening coverage and associated costs of potential screening strategies that combined targeting of key populations and decentralized general population screening. As treatment costs continue to decline due to breakthroughs in technologies and affordability, more attention and priority will be placed on the design and efficiency of screening programs as countries look to identify patients to initiate on treatment.
Pharos has been supporting Coalition Plus, a Paris-based advocacy organization, and ALCS, the leading HIV NGO in Morocco, to develop an investment case for HCV treatment scale-up in Morocco. In 2016, the Moroccan Ministry of Health developed a five-year HCV strategy that included ambitious treatment targets. Pharos has been supporting the costing, cost-effectiveness, and budget impact analysis of this strategy as well as evaluating the costs of inaction and alternative scale-up trajectories. ALCS hopes to use this supplemental evidence-base to advocate for accelerated scale-up within the country.
Pharos has also been working with Coalition Plus in Indonesia. Here we are supporting PKNI, the drug user’s network of Indonesia, in developing a preliminary investment case for scale-up. To date, Indonesia has not yet developed a national hepatitis strategy. We are currently modelling several elimination scenarios and estimating the costs and cost-effectiveness of each in order to inform the government’s decision-making process as it seeks to develop a strategy and future targets. PKNI plans to use this work to advise the government in the development of its future policy and to advocate for increased investment in hepatitis C nationally.
Similar to South Africa, Senegal has developed a comprehensive five-year national strategy for both HBV and HCV. We are currently supporting the costing and impact modelling of this strategy in order to estimate resource needs and inform a resource mobilization strategy.
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.
Team Members Involved: Robert Hecht, Miloud Kaddar, Stephen Resch, Teresa Guthrie, Tim Hallett, Carl Schutte, Diana Gonzalez, and Lindsey Hiebert.