Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study

Wu, Meiyu; Ma, Jing; Wang, Xuehong; Li, Sini; Tan, Chongqing; Xie, Ouyang; Li, Andong; Lim, Aaron G; Wan, Xiaomin

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Original Article

Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study

Meiyu Wu^1,2, Jing Ma³, Xuehong Wang⁴, Sini Li⁵, Chongqing Tan^1,2, Ouyang Xie^1,2, Andong Li^1,2, Aaron G Lim⁶, Xiaomin Wan^1,2

¹Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
²Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
³Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
⁴Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
⁵The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
⁶Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

Correspondence :

Aaron G Lim ,
Email: aaron.lim@bristol.ac.uk
Xiaomin Wan ,
Email: wanxiaomin@csu.edu.cn

Received: August 13, 2024 Revised: November 12, 2024 Accepted: December 2, 2024

ABSTRACT

Background
The WHO set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination.
Methods
Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022-2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths.
Results
The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs (PWID) annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022-2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868).
Conclusions
Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost effective.

KeyWords: Hepatitis C; Elimination; Cost-effectiveness; Health outcomes; China