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Can investment in hepatitis C treatment be cost saving?

Keith Alcorn
24 November 2020
Madeline Adee, Massachusetts General Hospital Institute for Technology Assessment. © The Liver Meeting Digital Experience™ 2020

Direct-acting antiviral treatment for hepatitis C can be cost saving for some countries within five to ten years, especially if they can negotiate lower drug prices, a study presented online at this month’s AASLD Liver Meeting shows.

Madeline Adee of Massachusetts General Hospital Institute for Technology Assessment presented results of a 158-country comparative study of the cost-saving impact of direct-acting antiviral treatment for hepatitis C.

The World Health Organization’s goals for hepatitis C elimination by 2030 challenge countries to diagnose 90% of people with hepatitis C and treat 80% of people diagnosed with chronic hepatitis C over the next decade.

Some countries – including Australia, the United Kingdom, Japan and Spain – are on course to achieve these goals before 2030 due to national planning, ambitious targets, well developed healthcare infrastructure and drug price agreements that make treatment affordable. But even so, only one in four higher-income countries will achieve hepatitis C elimination by 2030 and lower- and middle-income countries are even further behind.

To convince governments to invest in hepatitis C elimination, policy makers must be persuaded that as well as reducing deaths and illness, hepatitis C treatment will eventually achieve savings in healthcare costs. They also need to know what prices to aim for in negotiations with pharmaceutical companies, as the prices paid for drugs will influence the speed at which immediate treatment achieves future savings.

To assess when and at what price countries might achieve cost savings by treating hepatitis C, the Institute for Technology Assessment research team applied an existing model of hepatitis C disease progression to epidemiological and healthcare costs for 158 countries. They compared the impact of treatment to no treatment to identify what price paid for direct-acting antivirals would achieve cost saving within five years.

Comparing countries, the study found that whereas treatment higher-income countries (western Europe, North America, Australasia, South Korea and Japan) would be cost saving within five years at a treatment cost between $2001 and $9500 per treatment course, treatment in upper-middle-income countries including Argentina, Chile, Mexico, Turkey, Russia and Malaysia would need to be priced between $1001 and $2000 per course for the expenditure to be cost saving within five years.

For China, Iran and Thailand – countries with a high prevalence of hepatitis C – treatment would need to be priced between $501 and $1000 to be cost saving. Several large middle-income countries with high burdens of hepatitis C – Brazil, Egypt, India, Indonesia and Ukraine – would need to pay between $150 and $500 for treatment to be cost saving.

Lower-income countries in sub-Saharan Africa and Pakistan could expect treatment to be cost saving within five years only if they paid less than $150 per treatment course.

Based on data supplied to the researchers, only eleven countries have achieved direct-acting antiviral prices that would lead to treatment being cost saving in five years, including Chile, Belarus, Kazakhstan, Ukraine, India and Pakistan. Few countries had achieved prices that would enable treatment to become cost saving within ten years.

In the majority of countries that supplied price data, treatment would become cost saving over the lifetime of the treated individual, but in high-income countries and the countries with the lowest incomes, the prices reported for direct-acting antiviral treatment are so high, the costs of treatment will never be recouped by other savings on health care.

The study also looked at the impact of dramatic reductions in the cost of direct-acting antivirals. If the cost of a treatment course fell to $90, it would take between 1.5 years and 17.2 years for treatment to become cost saving in lower-income countries. In higher-burden lower-middle-income countries, treatment at this price would be cost saving within three years.


Adee M et al. Can hepatitis C treatment with direct-acting antivirals be cost saving? A global modeling study of 158 countries. AASLD Liver Meeting, abstract 56, 2020.