Lindsey Hiebert1, Robert Hecht2, Shan Soe-Lin2, Rosmawati Mohamed3, Fatiha H Shabaruddin4, Syed Mukhtar Syed Mansor3, Maznah Dahlui5, Amirah Azzeri5, Scott A McDonald6. 1. Pharos Global Health Advisors, Boston, MA, USA. Electronic address: lindsey@pharosglobalhealth.com. 2. Pharos Global Health Advisors, Boston, MA, USA. 3. Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 4. Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 5. Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 6. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.
Abstract
BACKGROUND: In Malaysia, more than 330 000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. OBJECTIVES: To estimate the required coverage and costs of a national screening strategy to inform the launch of an HCV elimination program. METHODS: We designed an HCV screening strategy based on a "stepwise" approach. This approach relied on targeting of people who inject drugs in the early years, with delayed onset of widespread general population screening. Annual coverage requirements and associated costs were estimated to ensure that the World Health Organization elimination treatment targets were met. RESULTS: In total, 6 million individuals would have to be screened between 2018 and 2030. Targeting of people who inject drugs in the early years would limit annual screening coverage to less than 1 million individuals from 2018 to 2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million ($58 million). Proportional to coverage targets, 60% of program costs would fall from 2026 to 2030. CONCLUSIONS: This exercise was one of the first attempts to conduct a detailed analysis of the required screening coverage and costs of a national HCV elimination strategy. These findings suggest that the stepwise approach could delay the onset of general population screening by more than 5 years after the program's launch. This delay would allow additional time to mobilize investments required for a successful general population screening program and also minimize program costs. This strategy prototype could inform the design of effective screening strategies in other countries.
BACKGROUND: In Malaysia, more than 330 000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. OBJECTIVES: To estimate the required coverage and costs of a national screening strategy to inform the launch of an HCV elimination program. METHODS: We designed an HCV screening strategy based on a "stepwise" approach. This approach relied on targeting of people who inject drugs in the early years, with delayed onset of widespread general population screening. Annual coverage requirements and associated costs were estimated to ensure that the World Health Organization elimination treatment targets were met. RESULTS: In total, 6 million individuals would have to be screened between 2018 and 2030. Targeting of people who inject drugs in the early years would limit annual screening coverage to less than 1 million individuals from 2018 to 2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million ($58 million). Proportional to coverage targets, 60% of program costs would fall from 2026 to 2030. CONCLUSIONS: This exercise was one of the first attempts to conduct a detailed analysis of the required screening coverage and costs of a national HCV elimination strategy. These findings suggest that the stepwise approach could delay the onset of general population screening by more than 5 years after the program's launch. This delay would allow additional time to mobilize investments required for a successful general population screening program and also minimize program costs. This strategy prototype could inform the design of effective screening strategies in other countries.
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