# Cost‐Effectiveness of Hepatitis C Virus Case Finding and Treatment in Eastern Europe and Central Asia

## TL;DR

This study evaluates whether treating all hepatitis C virus cases or focusing on drug users is cost-effective in Eastern Europe and Central Asia.

## Contribution

The study provides new cost-effectiveness estimates for HCV treatment strategies in middle-income countries using country-specific data and modeling.

## Key findings

- Treating all HCV cases and targeting people who inject drugs both showed cost-effectiveness in most countries.
- Lower drug costs, such as through UNICEF, significantly improved cost-effectiveness ratios.
- Bulgaria and Russia had less favorable cost-effectiveness due to high treatment costs.

## Abstract

In 2024, < 10% of hepatitis C virus (HCV) cases were treated in Eastern Europe and Central Asia (EECA) and the burden remains high. We aimed to estimate the cost‐effectiveness of treating anyone with HCV (‘treat all’) or targeting people who inject drugs (PWID) in 14 middle‐income EECA countries.

We gathered costs of screening, confirmatory tests, direct‐acting antiviral (DAA) treatment and monitoring from published country‐specific data, Georgian costs from previous analyses, and UNICEF. We combined decision tree modelling with a dynamic transmission model of HCV calibrated for each EECA country to calculate quality‐adjusted life years (QALYs) gained by 2030 from 100 DAA treatments in 2024, for treat all compared to targeting PWID. We calculated incremental cost‐effectiveness ratios (ICERs, cost per QALY gained) relative to gross domestic product (GDP) per capita.

QALYs gained from 100 treatments ranged from 29‐55 if treat all and 25–90 if targeting PWID. Using country‐level costs, Bulgaria and Russia had ICERs above GDP per capita due to high DAA costs. For other countries, ICERs ranged from 18% to 89% of GDP (treat all) and 4%–89% (PWID). Using lower Georgian costs and UNICEF costs, the treat all ICERs were below 84% and 24% of GDP for all countries, respectively, except Bosnia, while the ICERs when targeting PWID were below 64% and 16% of GDP, respectively.

Strategies that treat all persons with HCV and target PWID are both likely to be cost‐effective in middle‐income EECA countries, particularly with broad access to low‐cost generic treatments such as through UNICEF procurement.