Impact case study database

Burden and Global Strategies

Estimates of the burden of viral hepatitis (1) were used by WHO to make the case for their new advocacy strategy [ A]. Model-based strategies for eliminating hepatitis as a public health threat and the associated programmatic and epidemiological targets were provided to WHO as an unpublished report (reference 2 in document [ A]) and subsequently published (2, 3 above). The resulting WHO strategy to achieve elimination of hepatitis B and C by 2030 [ A] directly cites the outputs from this work - specifically the targets and their associated estimated impact. The construction of the five pillars of the strategy (“ Reaching five prevention and treatment service coverage targets would eliminate hepatitis B and C as public health threats”, page 6 ) directly refers to the modelling research. The economic analyses presented as part of the strategy ([ A], Section F) directly reproduces analyses undertaken by the researchers. The strategy was presented to the WHO Executive Board in 2015 and subsequently adopted by WHO as the Global Health Sector strategy on viral hepatitis 2016-2021 [ B]. These programmatic areas and targets are the benchmarks by which WHO monitors progress of countries in respect of its aim to combat hepatitis, as confirmed in a WHO-authored article [ C]. Today 87% of persons living with hepatitis reside in a country with a national plan for hepatitis [ D] that is based on, or draws reference from, the WHO health sector strategy [ B] that the Imperial research directly contributed to. The WHO authors of [ C] confirm that the targets have led to the initiation of action plans in many countries: “ As a result, many countries have initiated work to formulate national action plans, starting with initial assessments”.

Introduction of Birth Dose Vaccination

As one of three independent modelling teams, the Imperial researchers adapted their model developed in academic references (2,3) and worked with GAVI to provide projections of the impact of the timely birth dose to inform their hepatitis B birth dose vaccine investment case [ E]. In this it was shown that GAVI support for birth dose introduction could avert between 300,000 and 1,200,000 perinatal infection-related deaths between 2021 and 2035 and that this would be highly cost-effective (USD72-USD403 per death averted). The GAVI investment strategy relied on five primary criteria when ranking proposed new vaccine introductions - two of which (health impact and value for money) directly used the impact and cost-effectiveness estimates that the Imperial team provided [ F]. Birth-dose hepatitis B vaccine was recommended to the Gavi board for introduction from 2021 and adopted at its November 2018 meeting subject to successful replenishment that has now been confirmed.

Introduction of Tenofovir in Chinese National Insurance Program

Imperial modelling of the need to invest in hepatitis B control in China formed one of the case studies in the WHO advocacy strategy [ A, Box 4 page 10]. This work was expanded to explore the impact and cost-effectiveness of introducing tenofovir into the Chinese national insurance program. A preprint of this work (subsequently published academic reference 4) was shared with the WHO China office and formed part of a WHO (China) policy brief to government [ G]. This was the major piece of research motivating a policy change [ H] whereby tenofovir became included within the Chinese national insurance program [ I] leading to the reduction in cost of tenofovir for patients from ¥ 49.0 to ¥ 16.6 per day, or less [ I]. In a study of patients at selected hospitals, the proportion of patients being treated with first-line recommended drugs increased from 41.9% (2010) to 92.8% (2019).

Population-wide screening for HBV in West Africa

The Imperial-led PROLIFICA trial is cited as a case study in the WHO advocacy strategy [ A, Box 5 page 11]. The evidence that this trial generated on the efficacy and cost-effectiveness of population wide screening for HBV in West Africa is cited in the WHO Guidelines for screening of hepatitis B and C [ J]. The WHO is required to consider the cost and feasibility of a strategy it may recommend, and the research at Imperial was the only such information available for low-income countries [ J, pages 40 and 50]. This research is also reproduced as supporting evidence on cost-effectiveness in the Annex [ J]. As a consequence of the research, these guidelines gave, for the first time, a ‘conditional recommendation’ that testing should be made available to the general population in low-income settings with high prevalence of hepatitis B.