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‘Think outside the box’ to finance HCV elimination
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An important barrier to hepatitis elimination is the upfront costs, which may be subverted with a range of financing mechanisms, according to data from international economic analyses presented at the World Hepatitis Summit 2017.
“The original purpose of the Polaris Observatory was to focus on the disease burden and help national governments know how many people are infected, diagnosed and treated,” Homie A. Razavi, PhD, managing director at the Center for Disease Analysis, Colorado, told Healio.com/Hepatology. “What’s become clear is that financing is a major barrier to achieving the WHO elimination targets, so we’ve been focusing now on how to support countries with financing mechanisms and running economic analyses to see what it will cost to achieve elimination.”
Upfront vs. long-term costs
Through the Polaris Observatory, developed and managed by the Center for Disease Analysis, Razavi and colleagues have analyzed data on hepatitis treatment costs and cure rates from 27 countries, of which 17 allowed the data to be published.
According to Razavi, the cost of achieving the WHO targets was less expensive in every country they looked at compared with “doing nothing,” independent of whether the country was low-income like Ethiopia or a high-income country like the U.S. or Saudi Arabia.
“The issue is that the governments have to spend more upfront to achieve these targets,” Razavi said. “In about 10 to 15 years, they’re going to save a lot more money because they won’t have as many liver cancer patients, as many liver transplants, or cirrhotic people being hospitalized.”
Razavi explained that the problem is like buying a house. “You can rent forever, and the rent goes up each year, and you know what your commitment is, but you know if you buy a house that in 15 years when the mortgage is paid the house is yours,” he said. “You’re actually saving a lot of money.”
Curative therapy
The other problem the researchers discovered is that ministry of health members, policy makers, and donors seem to compare the goal of hepatitis elimination with “similar promises” made that expanded HIV treatment would lead to reduced disease rates. What is being misunderstood, Razavi said, is that the curative therapies for hepatitis are not the same as the chronic treatments for HIV.
“Curative therapies have not been around; this is the first example of a large-scale curative therapy,” Razavi said. “Hepatitis elimination is not like HIV, these are not chronic treatments. We’re talking about short-term, curative therapy. So, in fact, independent of whether a country is high-income, low-income or middle-income, elimination is less costly than not doing anything.”
Getting creative
“We’ve talked with plenty of donors and what we hear is that there is ‘donor fatigue.’ They are tired of doing the same thing and not seeing significant changes and outcomes. What they don’t want to do is continue giving money the same way they have. What they’ve challenged us to do is to think innovatively. One of the concepts they keep pushing is a catalystic investment: the donors are willing to provide small investments to drive awareness and activities such as screening that leads to much bigger outcomes.”
The results of the Polaris Observatory analyses also showed that donors would be interested in the concept of loans. “If they can get their money back over 10 to 15 years,” Razavi said, “then they can reinvest in other programs. The nice thing about donors and going through donors for this is the fact that they’re not looking to make money, so the interest rates with these loans are quite low, even close to zero.”
In addition to the Polaris Observatory, the Center for Disease Analysis developed the non-profit Global Procurement Fund, which was designed to provide access to low-cost, quality medicines and diagnostics through pooled procurement.
According to Razavi, while hepatitis B and hepatitis C treatments and diagnostics can be provided to low-income countries at their original low costs, the treatments and diagnostics face significant markups once processed through customs and a distributor. As an example, an RNA diagnostic that costs $30 initially may cost up to $200 in Ethiopia by the time it reaches the patient.
What the members of the Global Procurement Fund have proposed is that while they can provide the low-cost drugs and diagnostics, the governments need to do what they can to make sure there are no significant financial markups in getting the treatments to patients.
“There are a number of different mechanisms available to eliminate hepatitis, but what it does require is people to get outside their comfort zones — whether we’re talking about bonds or forfeiting importation taxes, we really do need to think outside the box if want to achieve this,” Razavi said. – by Talitha Bennett
Disclosure: Razavi reports no relevant financial disclosures. The CDA Foundation, Polaris Observatory and the Global Procurement Fund are funded by private donations and grants from other non-for-profits. The Center for Disease Analysis has received research funding from AbbVie, Intercept and Gilead, but they had no influence over the design, implementation or publication of the studies.