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Objectives Testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are highly effective, high-impact interventions. This article aims to estimate the cost-effectiveness of scaling up these interventions by scenarios, regions, and income groups. Methods We modeled costs and impacts of hepatitis elimination in 67 low- and middle-income countries from 2016 to 2030. Costs included testing and treatment commodities, healthcare consultations, and future savings from cirrhosis and hepatocellular carcinomas averted. We modeled disease progression to estimate disability-adjusted life-years (DALYs) averted. We estimated incremental cost-effectiveness ratios (ICERs) by regions and World Bank income groups, according to 3 scenarios: flatline (status quo), progress (testing/treatment according to World Health Organization guidelines), and ambitious (elimination). Results Compared with no action, current levels of testing and treatment had an ICER of $807/DALY for HBV and –$62/DALY (cost-saving) for HCV. Scaling up to progress scenario, both interventions had ICERs less than the average gross domestic product/capita of countries (HBV: $532/DALY; HCV: $613/DALY). Scaling up from flatline to elimination led to higher ICERs across countries (HBV: $927/DALY; HCV: $2528/DALY, respectively) that remained lower than the average gross domestic product/capita. Sensitivity analysis indicated discount rates and commodity costs were main factors driving results. Conclusions Scaling up testing and treatment for HBV and HCV infection as per World Health Organization guidelines is a cost-effective intervention. Elimination leads to a much larger impact though ICERs are higher. Price reduction strategies are needed to achieve elimination given the substantial budget impact at current commodity prices.

OBJECTIVES: Oral ibandronate (ibandronic acid) is a bisphosphonate approved in the UK for treatment of bone metastases from breast cancer. Administration of oral ibandronate oncedaily can be easily combined with oral hormonal therapy, saving costs of iv bisphosphonate administration and monitoring. We used cost-effectiveness (C/E) modelling to compare oral ibandronate with iv zoledronic acid or iv generic pamidronate in this setting. METHODS: The model assumed a UK NHS perspective with a duration of 14.3 months (expected average survival). Patients were assumed to receive oral hormonal therapy for 53% of their survival. Primary outcomes were direct Health Care costs and QALYs. Resource use data for iv bisphosphonates came from a published micro-costing study (validated through review by a UK clinician); costs were calculated using a unit cost database. Monthly drug acquisition costs were £195 for oral ibandronate and iv zoledronic acid, and £165 for iv generic pamidronate. The cost of managing skeletal-related events (SREs) came from a published study. Renal adverse events with monitoring and treatment costs were assumed for zoledonic acid. Efficacy was calculated as the relative risk reduction (RR) of SREs; utility scores were applied to time with/without an SRE (SRE duration assumed 1 month). RESULTS: The projected total cost was £297 less/patient with oral ibandronate than with zoledronic acid, and £1087 less than with generic pamidronate. Oral ibandronate led to a gain of 0.02 QALYs (due to SRE RR and bone pain relief), making it the economically dominant treatment option. For completeness, C/E results for iv ibandronate will also be presented, demonstrating C/E. CONCLUSIONS: This study demonstrated the use of C/E modelling to compare oral versus iv bisphosphonates using published data validated by expert clinician review. Oral ibandronate was found to be cost-effective for the management of bone metastases from breast cancer in patients receiving oral hormonal therapy.