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The investment case for hepatitis B and C in South Africa: adaptation and innovation in policy analysis for disease program scale-up

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Title: The investment case for hepatitis B and C in South Africa: adaptation and innovation in policy analysis for disease program scale-up
Authors: Hecht, R
Hiebert, L
Spearman, WC
Sonderup, MW
Guthrie, T
Hallett, TB
Nayagam, S
Razavi, H
Soe-Lin, S
Vilakazi-Nhlapo, K
Pillay, Y
Resch, S
Item Type: Journal Article
Abstract: 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.
Issue Date: 1-May-2018
Date of Acceptance: 30-Jan-2018
URI: http://hdl.handle.net/10044/1/58070
DOI: https://dx.doi.org/10.1093/heapol/czy018
ISSN: 1460-2237
Publisher: Oxford University Press (OUP)
Start Page: 528
End Page: 538
Journal / Book Title: Health Policy and Planning
Volume: 33
Issue: 4
Copyright Statement: © The Author(s) 2018. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/bync-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
Disease control
health planning
cost-effectiveness analysis
developing countries
international health policy
policy implementation
Cost-Benefit Analysis
Developing Countries
Health Planning
Hepatitis B
Hepatitis C
Policy Making
Resource Allocation
South Africa
1605 Policy And Administration
1117 Public Health And Health Services
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-02-26
Appears in Collections:Department of Surgery and Cancer