Hepatitis C elimination in Uruguay may be feasible and cost-saving: A modeling study
Victoria Mainardi, Huaiyang Zhong, Alec Aaron, Daniela Olivari, Solange Gerona, Andrés Balsamo, Camila Picchio, Julio Medina, Sebastián Marciano, Lindsey Hiebert, John W. Ward, Jagpreet ChhatwalBackground
The World Health Organization (WHO) targets hepatitis C virus (HCV) elimination by 2030. Despite universal access to direct-acting antivirals, Uruguay has faced gaps in HCV diagnosis and linkage-to-care.
Objective
To estimate HCV burden and evaluate the epidemiological and economic impact of alternative testing and treatment strategies in Uruguay, including those required to achieve WHO elimination targets.
Design
Decision-analytic modeling study using the Hep C Elimination Tool, an individual-level state-transition microsimulation model.
Methods
We conducted a national HCV disease burden assessment, including viremic prevalence, incidence, liver-related morbidity, mortality, and cascade-of-care indicators, using multiple data sources. The calibrated model simulated two scenarios Status Quo, reflecting current screening and treatment levels (5% and 70%), and Elimination, defined by testing and treatment scale-up required to achieve WHO targets (90% diagnosis, 80% treatment, and 80% incidence reduction). Two follow-up rate assumptions (reflecting progression from antibody positivity to RNA confirmation and treatment initiation) were applied: current (based on observed national data) and maximized (assuming complete progression from diagnosis to treatment). Outcomes included projected HCV prevalence, incidence, liver-related mortality, diagnosis and treatment coverage by 2030, and cumulative healthcare costs through 2050.
Results
In 2022, an estimated 19,559 individuals were living with chronic HCV infection in Uruguay. Under Status Quo scenario with current follow-up, diagnosis and treatment coverage would reach 23% and 17% by 2030, with limited incidence reduction (−13%) and largely unchanged liver-related mortality. In contrast, elimination-aligned strategies with expanded screening (15 to 30%) and treatment uptake (70 to 80%), with maximized follow-up, achieved up to 91% diagnosis and treatment coverage, 89% incidence reduction, and 56% liver-related mortality reduction by 2030. Cumulative undiscounted expenditures were reduced by up to 43.5% versus Status Quo, with savings attenuated but preserved after discounting.
Conclusion
Model projections suggest that HCV elimination in Uruguay may be feasible and cost-saving under scenarios that substantially expand testing and improve linkage to care. These findings highlight the potential value of scaling up diagnostic and treatment to reduce HCV burden and inform national planning efforts.