Initial Work: Cost Analysis of Hepatitis C Control Program in the Framework of the National Action Plan for Viral Hepatitis Control in 2020-2024

Executive Summary

A significant gap between target of hepatitis C control and the high burden of the disease in Indonesian is reflected in the National Action Plan (NAP) for Viral Hepatitis Control 2020-2024. The decision to set a less aggressive target may be related to the limited funding of the government to scale up the hepatitis C control. However, in order to understand this gap and its implication on the cost for implementing the program, it is crucial to conduct economic evaluation as an analysis to assess the overall cost needed to implement the NAP in the context of hepatitis C elimination by 2030; to determine the health impacts; to measure cost effectiveness of the action plan; and to identify potential savings for the health sector. This analysis is expected to provide recommendations of more detailed program planning and in accordance with the need to achieve the goals of hepatitis C control. Improving access to prevention and treatment is a key strategy to achieve equity in health access.

In the context of limited resources, the main question is what priorities need to be made in order to achieve the NAP target and in the longer run, can these efforts contribute to achieve the target of hepatic C elimination by 2030? In particular, the more operational questions are as follows:

• How much and what will it cost to implement the NAP for hepatitis C control over the next five years and how much will it take if we plan to eliminate hepatitis C by 2030?

• Will the overall costs of controlling hepatitis C be affordable to the government? What priorities should the government choose that can reduce costs significantly but still have an impact on achieving the NAP target or elimination?

• What impact might these efforts have on the morbidity or mortality associated with hepatitis C?

• Will hepatitis C control programs be cost-effective? Will this effort ultimately provide savings for government as a result of reduced spending to treat the disease?

Ideally, by taking into account the development of an economic evaluation model for the hepatitis C program at the national level as identified from the previous literature review, the various questions above can be responded by conducting an economic evaluation using the investment case approach. In addition to being able to answer the questions above, this approach can be used to estimate the clinical, social and financial benefits of pursuing the NAP targets and eliminating hepatitis C. The results of the analysis will also allow it to be used as evidence for advocacy and mobilizing resources for program implementation.

Even though it has great potential benefits by implementing the investment case for the NAP for Viral Hepatitis Control 2020-2024, this investment case analysis may only be done if there is sufficient time due to the complexity in the preparation and analysis process. The use of this method needs to take into account revisiting the NAP target in order to be in line with the hepatitis C elimination by 2030. Calculating cost of the NAP taking into account the context of elimination targets will significantly affect the scenarios that can be developed for the first five years to achieve the NAP target or achieve elimination by 2030.

To respond to the need for an adequate analysis and to consider the available time, a programmatic cost analysis design is proposed. Programmatic cost analysis is the initial work of the investment case steps. Cost analysis is one of four types of economic evaluation (the other three are cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis). Cost analysis is expected to be able to compare the costs required to implement the NAP with the costs of current program (status quo). In addition, the analysis of program costs is also expected to produce the proper financing plan to address the gaps that are currently known. The final result of the analysis gives the total program cost or average cost. The results of program cost analysis can be used in a more complex economic evaluation, such as the cost effectiveness analysis as part of the investment case approach.