Additional resource needs for viral hepatitis elimination through universal health coverage: projections in 67 low-income and middle-income countries, 2016-30
Additional resource needs for viral hepatitis elimination through universal health coverage: projections in 67 low-income and middle-income countries, 2016-30
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DOI：
10.1016/s2214-109x(19)30272-4
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发表时间：
2019-09-01
影响因子：
34.3
通讯作者：
Hirnschall, Gottfried
中科院分区：
文献类型：
--
作者：
Tordrup, David;Hutin, Yvan;Hirnschall, Gottfried
世界卫生大会呼吁到2030年消除病毒性肝炎这一公共卫生威胁（即发病率为-90%，死亡率为-65%）。然而，世卫组织2017年实现与卫生相关的可持续发展目标的成本预测并不包括肝炎检测和治疗所需的资源。我们的目的是估计增加规模的干预措施，检测和治疗肝炎WHO的投资scenaries.Methods我们增加了建模的实施世卫组织建议的肝炎检测和治疗的2017年世卫组织的成本预测的成本增加的商品成本。我们量化了2016- 2030年67个低收入和中等收入国家对诊断检测、药物、卫生工作者时间和项目支持的额外需求。一个进展情景扩大了干预措施的规模，一个更雄心勃勃的情景被模拟为到2030年实现消除。我们使用了2018年诊断和仿制药的最优惠价格。我们估计的总成本和额外的投资需要超过2016年的基线cost.Findings的预测考虑的67个国家包括2.3亿人与B肝炎病毒（HBV）和52万人与丙型肝炎病毒（HCV; 90%和73%，分别为世界的总数）。根据进展设想，将对32.5亿人（24亿人感染乙型肝炎病毒，8.5亿人感染丙型肝炎病毒）进行检测，并对5，820万人（2，410万人感染乙型肝炎病毒，3，410万人感染丙型肝炎病毒）进行治疗（额外总费用为271亿美元）。在雄心勃勃的情景下，116.31亿人（55.02亿人检测HBV，61.29亿人检测HCV），9380万人（3220万人感染HBV，6160万人感染HCV）（总额外费用为587亿美元），避免450万人过早死亡，并导致到2030年增加5 150万健康生命年。然而，如果在13个受药物专利保护的国家仍然无法获得负担得起的HCV药物，那么雄心勃勃的方案的额外成本将增加到1180亿美元。从2016年至2030年，消除肝炎将使世卫组织雄心勃勃的加强卫生保健情景成本增加1.5%，避免额外4.6%的过早死亡，并增加额外9.6%的健康生命年。解释在所有国家获得负担得起的药物将是实现消除肝炎的关键。这项研究表明，在全民健康覆盖的背景下，消除艾滋病毒是可行的。它指出商品是总体价格标签的关键决定因素，并提出了降低成本战略的备选办法。版权所有（C）2019世界卫生组织;许可人Elsevier。
Background The World Health Assembly calls for elimination of viral hepatitis as a public health threat by 2030 (ie, -90% incidence and -65% mortality). However, WHO's 2017 cost projections to achieve health-related Sustainable Development Goals did not include the resources needed for hepatitis testing and treatment. We aimed to estimate the incremental commodity cost of adding scaled up interventions for testing and treatment of hepatitis to WHO's investment scenarios.Methods We added modelled costs for implementing WHO recommended hepatitis testing and treatment to the 2017 WHO cost projections. We quantified additional requirements for diagnostic tests, medicines, health workers' time, and programme support across 67 low-income and middle-income countries, from 2016-30. A progress scenario scaled up interventions and a more ambitious scenario was modelled to reach elimination by 2030. We used 2018 best available prices of diagnostics and generic medicines. We estimated total costs and the additional investment needed over the projection of the 2016 baseline cost.Findings The 67 countries considered included 230 million people living with hepatitis B virus (HBV) and 52 million people living with hepatitis C virus (HCV; 90% and 73% of the world's total, respectively). Under the progress scenario, 3250 million people (2400 million for HBV and 850 million for HCV) would be tested and 58.2 million people (24.1 million for HBV and 34.1 million for HCV) would be treated (total additional cost US$ 27.1 billion). Under the ambitious scenario, 11 631 million people (5502 million for HBV and 6129 million for HCV) would be tested and 93.8 million people (32.2 million for HBV and 61.6 million for HCV) would be treated (total additional cost $58.7 billion), averting 4.5 million premature deaths and leading to a gain of 51.5 million healthy life-years by 2030. However, if affordable HCV medicines remained inaccessible in 13 countries where medicine patents are protected, the additional cost of the ambitious scenario would increase to $118 billion. Hepatitis elimination would account for a 1.5% increase to the WHO ambitious health-care strengthening scenario costs, avert an additional 4.6% premature deaths, and add an additional 9.6% healthy life-years from 2016-30.Interpretation Access to affordable medicines in all countries will be key to reach hepatitis elimination. This study suggests that elimination is feasible in the context of universal health coverage. It points to commodities as key determinants for the overall price tag and to options for cost reduction strategies. Copyright (C) 2019 World Health Organization; licensee Elsevier.