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Eliminating hepatitis C in Pakistan could yield a return-on-investment of US$9.10 billion

22 October 2021 

Pakistan has one of the highest rates of hepatitis C virus (HCV) infection in the world, accounting for over 10% of global HCV infections. A new modelling study led by the University of Bristol, UK, suggests that achieving the World Health Organization goal of eliminating HCV as a public health problem by 2030 in Pakistan is likely to be highly cost-effective by 2030, cost-saving by 2031, and could deliver US$9.10 billion in savings to the Pakistan national economy by 2050. 

Hepatitis virus in infected organism

The study, a collaboration across the University of Bristol, the Burnet Institute in Australia, and Aga Khan University in Pakistan, found that achieving HCV elimination in Pakistan could yield substantial societal health and economic benefits. These benefits include saving 333,000 lives and averting considerable morbidity due to ill health, leading to improvements in health-related quality of life and workforce productivity. 

The research findings, published in PLOS Medicine, looked beyond the direct investment required to reach HCV elimination by evaluating the productivity and health gains to estimate the potential return-on-investment for eliminating HCV in Pakistan. The authors also investigated the costs saved from partially integrating HCV testing services into existing healthcare infrastructure.

Dr Aaron Lim, Research Fellow in Infectious Disease Mathematical Modelling at the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol and lead author of the study, said: “Countries may be substantially underestimating both how much HCV is costing their economy and the benefits of elimination. 

“We have previously estimated that a direct investment of US$3.87 billion is required for HCV elimination in Pakistan, but that previous study did not capture the wider societal benefits of achieving HCV elimination, such as gains in workforce productivity due to people being free of HCV infection. Understanding these wider benefits are important for informing decision-making.

“Our modelling suggests that when we include these indirect savings, investing in HCV elimination can become cost-saving to the economy in 10 years’ time.”

However, Dr Lim says that there is a trade-off between needing to invest early and the return-on-investment occurring later on. 

“This is one reason we looked at partial integration of testing services alongside standalone provision. We found that with an integrated approach, costs could be reduced significantly.”

Dr Nick Scott, from the Burnet Institute and joint lead author, said that “this study is critical because it provides the evidence needed to support continued investment in HCV elimination as a priority for Pakistan.”

Peter Vickerman, Professor of Infectious Disease Modelling from the University of Bristol, said: “Our study shows that through achieving HCV elimination, Pakistan can save over 300,000 lives while also saving money, especially if the required increase in HCV screening is integrated into existing healthcare services.”

Hepatitis C is a blood-borne virus infecting 71 million people worldwide (about 1% of the world’s population) and causes 400,000 deaths each year.

Paper: Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis by Aaron G Lim, Nick Scott, Josephine G Walker, Saeed Hamid, Margaret Hellard and Peter Vickerman. Published in PLoS Medicine. 19 October 2021.


Further information

About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol 

The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation. 

The NIHR HPRU in Behavioural Science and Evaluation is a partnership between the UK Health Security Agency (UKHSA) and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England. 

Each NIHR HPRU undertakes high quality research that is used by UKHSA to keep the public safe from current and emerging public health threats.

About the NIHR 

The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.