The investment case for hepatitis B and C in South Africa: adaptation and innovation in policy analysis for disease program scale-up.
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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DOI：
10.1093/heapol/czy018
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发表时间：
2018-05-01
影响因子：
3.2
通讯作者：
Resch S
中科院分区：
文献类型：
--
作者：
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
尽管世卫组织已经批准了消除肝炎的全球目标，但大多数国家尚未建立乙型和丙型肝炎规划，这两种疾病每年造成3.2亿人感染，100多万人死亡。这种缓慢反应的一个原因是缺乏强有力的、令人信服的分析，表明国家HBV/HCV规划可以对这些流行病产生重大影响，并以具有成本效益和负担得起的方式挽救生命。在此背景下，我们的团队采用投资案例方法为南非制定了一项全国性肝炎行动计划，该计划以当地利益攸关方密集参与的过程为基础。使用作者设计的基于成分的自下而上的成本计算工具估算每个活动的成本。通过使用先前开发的模型，根据南非的人口和流行病概况进行校准，模拟该行动计划的四项优先干预措施（乙肝病毒出生剂量疫苗接种、预防母婴传播、乙肝病毒治疗和丙肝病毒治疗），评估了该行动计划的健康影响和成本效益。据估计，该行动计划在2017-2021年期间需要38亿兰特（2.94亿美元），约占政府预计卫生支出的0.5%。在最初的5年期间扩大治疗规模将避免1.3万例与乙肝病毒相关的死亡和7000例与乙肝病毒相关的死亡。如果按照世卫组织的目标在2021年以后继续扩大规模，就可以避免超过67万例新感染、20万例hbv相关死亡和3万例hbv相关死亡。《行动计划》的增量成本效益估计为每个避免的dal10美元，低于人均国内总产值一半的基准。我们的分析表明，拟议的扩大规模可以在南非的财政空间内容纳，并且代表了对稀缺资源的良好利用。南非正在讨论将预算分配给肝炎的问题。我们的工作说明了使用投资案例方法来评估扩大HBV/HCV服务的成本和相对优先级的价值和可行性。
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.
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影响因子：
3.7
作者：
Gilbert JA;Shenoi SV;Moll AP;Friedland GH;Paltiel AD;Galvani AP
通讯作者：
Galvani AP
影响因子：
5.5
作者：
Andersson, M. I.;Maponga, T. G.;Tedder, R. S.
通讯作者：
Tedder, R. S.
影响因子：
3.5
作者：
Mash, Robert;Kroukamp, Roland;Levitt, Naomi
通讯作者：
Levitt, Naomi
影响因子：
12.7
作者：
Lukhwareni, Azwidowi;Burnett, Rosemary J.;Mphahlele, M. Jeffrey
通讯作者：
Mphahlele, M. Jeffrey
影响因子：
1.1
作者：
Mdlalose, Nokukhanya;Parboosing, Raveen;Moodley, Pravi
通讯作者：
Moodley, Pravi