Developing a Hepatitis C Investment Case for Cambodia

The World Hepatitis Alliance (WHA), in partnership with the Ministry of Health in Cambodia and the Clinton Health Access Initiative (CHAI), is pleased to launch a new report: Developing a Hepatitis C Investment Case for Cambodia

The Need

Cambodia has one of the highest burdens of hepatitis C in the Western Pacific Region. With an estimated 257,000 chronic cases, there are more people living with hepatitis C in the country than there are living with HIV and active tuberculosis (TB) combined. Despite this,  access to hepatitis C testing and treatment is currently limited due to the lack of a public programme and high private sector costs.

Momentum has been growing in recent years for a public programme to tackle hepatitis C in the country. Hepatitis was listed as a priority area for action within Cambodia’s most recent national strategic health plan (2016-2020), and, in 2017, the National Centre for HIV/AIDS, Dermatology and STDs (NCHADS) secured funding from the Global Fund (using underspend on their grant) to diagnose and cure HIV/hepatitis C co-infected patients enrolled in their antiretroviral therapy (ART) programme. However, with limited global donor funding available, the launch of Cambodia’s hepatitis C programme hinges on the ability to secure a domestically funded budget.

Developing an investment case

The investment case for hepatitis C was developed by CHAI, the Communicable Disease Control Department of the Ministry of Health of Cambodia (CDC-MOH) and WHA, in parallel with the government’s National Strategic Plan for hepatitis (2020-2024) and new clinical guidelines.

It examined two different scenarios to better understand long-term costs to the country: the first maintained the status quo with no people living with hepatitis C treated through a public sector programme from 2020-2030; the second in which funding is secured and a plan is implemented to eliminate hepatitis C by 2030.

During development of the plan, CHAI, the Ministry and WHA held discussions to cost and set targets, drawing on the experiences of both the HIV/hepatitis C co-infection programme as well as those of stakeholders delivering HIV and TB programmes within the country.

A key consideration was to determine ownership of a future hepatitis programme within the MOH-CDC. Stakeholders agreed that an integrated approach which prioritised primary care service delivery would be more effective than setting up another stand-alone vertical disease programme.

The Findings

The investment case models showed that funding a public elimination program is less expensive than the cost of maintaining the status quo, saving USD $18.3 million, or $0.30 per USD invested. Since the investment case did not consider the indirect costs associated with hepatitis C such as absenteeism, productivity loss, and non-medical costs, this estimate is likely conservative.

The Future

Despite the progress made to date with the HIV/hepatitis C co-infection programme, the path to securing required resources for hepatitis elimination is not clear. Interviews held with key stakeholders within the Ministry and other national partners indicated a need to increase awareness and advocacy for the issue to strengthen political support for domestic financing.

In the short-term, this report should provide CDC-MOH with the necessary tools to advocate for dedicated financial resources to launch a hepatitis C programme. The longer-term objective is to grow those resources and secure external resources, if required, to reach the goal of elimination.