# Bridging Hepatitis C Care Gaps: A Modeling Approach for Achieving the WHO’s Targets in Ontario, Canada

## TL;DR

This study models how scaling up hepatitis C testing and treatment in Ontario can help meet WHO elimination targets by 2035, though not by 2030.

## Contribution

A novel decision-analytic model to quantify the service scale-up needed for HCV elimination in Ontario.

## Key findings

- Doubling antibody testing rates could achieve a 65% reduction in liver-related mortality by 2035.
- Improved RNA testing and treatment rates reduced liver-related deaths by 57% from 2015 levels.
- The proposed program is cost-effective if implementation costs stay under CAD 2.3 million per 100,000 people annually.

## Abstract

Background: The World Health Organization (WHO) has set hepatitis C (HCV) elimination targets for 2030. Understanding existing gaps in the “HCV care-cascade” is essential for meeting these targets. We aimed to identify the level of service scale-up needed along the “HCV care-cascade” to achieve the WHO’s HCV elimination targets in Ontario, Canada. Methods: By employing a decision analytic model, we projected the quality-adjusted life years (QALYs) and healthcare costs for individuals with HCV in Ontario. We increased RNA testing and treatment rates to 98%, followed by increasing antibody testing uptake until we achieved the WHO’s mortality target (i.e., a 65% reduction in liver-related mortality by 2030 vs. 2015). Results: Without scaling up by 2030, the expected QALYs and costs per person were 9.156 and CAD 48,996, respectively. Improved RNA testing and treatment rates reduced liver-related deaths to 3.3/100,000, a 57% reduction from 2015. Further doubling the antibody testing rates can achieve the WHO’s mortality target in 2035, but not in 2030. Compared to the status quo, such program would be cost-effective considering a 50,000 CAD/QALY gained threshold if annual implementation costs stayed under 2.3 M CAD/100,000 people. Conclusions: Doubling the antibody testing rates, along with increased RNA testing and treatment rates, showed promise in meeting the WHO’s goals by 2035.