Morocco investment case for hepatitis C: using analysis to drive the translation of political commitment to action

Abstract

# Background Worldwide more than 125 million people are infected with hepatitis C (HCV). New drugs, direct acting antivirals (DAAs) that can cure HCV in three months, are available in generic form at very low cost in over 100 low- and middle-income countries, yet few countries have launched national campaigns. In Morocco, more than 350,000 people are infected with chronic HCV infection yet only 1,500 individuals with mandatory social health insurance are currently treated each year with DAAs. Such treatment coverage is low for this group and is completely inaccessible to the remaining 70% of the population. # Methods To accelerate progress in Morocco, our team of advocates, clinicians, and health policy analysts developed an investment case, using a novel set of tools, that modeled HCV elimination by 2030 and estimated the health impact, costs, cost-effectiveness, return on investment, and budget implications of such an effort. # Results Our analysis suggests that Morocco could eliminate HCV and save over 50,000 lives by investing US\$650-715 million in a highly cost-effective manner (US\$1,700 per DALY averted, less than half per capita GDP) and by allocating 3.5% of the Ministry of Health's budget. # Conclusions The investment case has been accepted by the Ministry of Health, and Morocco has committed to putting 6,500 patients on treatment in the public sector in 2018-2019 for the first time, targeting the poorest who are eligible for a new social health insurance program. Our experience shows how the investment case method we followed can be used to drive decisions on HCV elimination in favor of more efficient and equitable use of resources.