Abstract

Background

Hepatitis C elimination may be possible with broad uptake of direct-acting antiviral treatments (DAAs).In 2016 the Australian government committed A$1.2 billion for five years of unlimited DAAs (March 2016 to Febru-ary 2021) in a risk-sharing agreement with pharmaceutical companies. We assess the impact, cost-effectiveness andnet economic benefits likely to be realised from this investment.

Methods

Mathematical modelling to project outcomes for 2016-2030 included: (S1) a counter-factual scenario (test-ing/treatment maintained at pre-2016 levels); (S2) the current status-quo (testing/treatment as actually occurred2016-2019, with trends maintained to 2030); and (S3) elimination scenario (S2 plus testing/treatment ratesincreased between 2021-2030 to achieve the WHO elimination targets).

Findings

S1 resulted in 68,800 new hepatitis C infections and 18,540 hepatitis C-related deaths over 2016-2030.The total health system cost (HCV testing, treatment, disease management) was A$3.01 billion and the cost of lostproductivity due to absenteeism, presenteeism and premature deaths was A$26.14 billion. S2 averted 15,700 (23%)new infections and 8,500 (46%) deaths by 2030, with a total health system cost of A$3.48 billion, A$472 millionmore than S1 (A$1.65 billion more in testing/treatment but A$1.20 billion less in disease costs; A$5,752 per QALYgained from a health systems perspective). Productivity loss over 2016-2030 was A$19.96 billion, A$6.17 less thanS1, making S2 cost-saving from a societal perspective by 2022 with a net economic benefit of A$5.70 billion by2030. S3 averted an additional 10,000 infections and 930 deaths compared with S2 and increased the longer-termeconomic benefit.

Interpretation

Five years of unrestricted access to DAAs in Australia has led to significant health benefits and islikely to become cost-saving from a societal perspective by 2022.

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