{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:34:53Z","timestamp":1781224493099,"version":"3.54.1"},"reference-count":66,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"HTAi Scholarship Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The aim of this study was to assess the cost effectiveness of a screening and treatment intervention approach for chronic HCV infection in Zimbabwe. Methods: Using a decision tree and a validated Markov model, we estimated the lifetime costs and health effects of screening for and treating HCV infections from a healthcare perspective. We evaluated three screening strategies, namely the following: i. no screening; ii. screening among the general population; and iii. screening among high-risk groups. Incremental cost effectiveness ratios were calculated for the strategies that were not dominated. We used deterministic and probabilistic sensitivity analyses to explore the impacts of parameter uncertainty on cost effectiveness outcomes. Results: The strategy of screening among high-risk groups and treating with sofosbuvir\/velpatasvir had an incremental cost of USD 1201 and incremental quality-adjusted life years (QALY) of 2.01, yielding an incremental cost effectiveness ratio (ICER) of USD 604 per QALY gained as compared to no screening. The ICER was below the 0.5 times the gross domestic product per capita parameter (USD 796), making the intervention potentially cost effective. The strategy to screen among the general population was dominated, because it costed more and resulted in fewer QALYs than its comparators. Conclusions: Screening for HCV among high-risk populations followed by treatment using sofosbuvir\/velpatasvir is cost effective under the assumptions made in this study.<\/jats:p>","DOI":"10.3390\/ijerph22040509","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:06:35Z","timestamp":1743141995000},"page":"509","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-Effectiveness of Screening and Treating Chronic Hepatitis C Virus Infection in Zimbabwe"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8208-7821","authenticated-orcid":false,"given":"Blessing","family":"Dzingirai","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"},{"name":"Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare P.O. Box MP 167, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leolin","family":"Katsidzira","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare P.O. Box MP 167, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J.","family":"Postma","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3216-7246","authenticated-orcid":false,"given":"Marinus van","family":"Hulst","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"},{"name":"Department of Clinical Pharmacy and Toxicology, Martini Hospital, 9728 NL Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9775-6581","authenticated-orcid":false,"given":"Nyashadzaishe","family":"Mafirakureva","sequence":"additional","affiliation":[{"name":"Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield S10 2TN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S2468-1253(21)00472-6","article-title":"Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: A modelling study","volume":"7","author":"Blach","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_2","unstructured":"(2024, August 20). Hepatitis-Number of Persons Living with Chronic Hepatitis. Available online: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/hepatitis---number-of-persons-living-with-chronic-hepatitis."},{"key":"ref_3","unstructured":"(2024, August 20). Hepatitis-Number of Deaths Caused by Chronic Hepatitis. Available online: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/hepatitis---number-of-deaths-caused-by-chronic-hepatitis."},{"key":"ref_4","unstructured":"World Health Organisation (2022). Global Health Sector Strategies on, Respectively, HIV, Viral Hepatitis and Sexually Transmitted Infections for the Period 2022\u20132030."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/S2468-1253(23)00408-9","article-title":"WHO hepatitis C elimination targets: The global equity challenge","volume":"9","author":"Heath","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1111\/jvh.13510","article-title":"Progress on the elimination of viral hepatitis in Zimbabwe: A review of the policies, strategies and challenges","volume":"28","author":"Dzingirai","year":"2021","journal-title":"J. Viral Hepat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s40471-021-00273-6","article-title":"Elimination of Viral Hepatitis in Low and Middle-Income Countries: Epidemiological Research Gaps","volume":"8","author":"Jaquet","year":"2021","journal-title":"Curr. Epidemiol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S2468-1253(23)00321-7","article-title":"Progress towards elimination of viral hepatitis: A Lancet Gastroenterology & Hepatology Commission update","volume":"9","author":"Cooke","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_9","unstructured":"(2024, August 20). Hepatitis-Chronic Hepatitis Treatment Rate as Percentage of Total Infected. Available online: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/hepatitis---chronic-hepatitis-treatment-rate-as-percentage-of-total-infected."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Dietz, C., and Maasoumy, B. (2022). Direct-Acting Antiviral Agents for Hepatitis C Virus Infection\u2014From Drug Discovery to Successful Implementation in Clinical Practice. Viruses, 14.","DOI":"10.3390\/v14061325"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"584","DOI":"10.2174\/1389557517666170913111930","article-title":"Recent Advancement of Direct-acting Antiviral Agents (DAAs) in Hepatitis C Therapy","volume":"18","author":"Das","year":"2018","journal-title":"Mini Rev. Med. Chem."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/14737167.2024.2348055","article-title":"A cost analysis of a simplified model for HCV screening and treatment at a tertiary hospital in Zimbabwe","volume":"24","author":"Dzingirai","year":"2024","journal-title":"Expert Rev. Pharmacoeconom. Outcomes Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100001","DOI":"10.1016\/j.jve.2020.06.001","article-title":"Price of a hepatitis C cure: Cost of production and current prices for direct-acting antivirals in 50 countries","volume":"6","author":"Barber","year":"2020","journal-title":"J. Virus Erad."},{"key":"ref_14","unstructured":"(2024, May 08). Zimbabwe FinScope Consumer Survey Report 2022. Available online: https:\/\/www.rbz.co.zw\/documents\/BLSS\/2022\/Zimbabwe_FinScope_Consumer_2022_Survey_Report.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12939-023-01868-9","article-title":"Inequality and private health insurance in Zimbabwe: History, politics and performance","volume":"22","author":"Mhazo","year":"2023","journal-title":"Int. J. Equity Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Serumondo, J., Penkunas, M.J., Niyikora, J., Ngwije, A., Kiromera, A., Musabeyezu, E., Umutesi, J., Umuraza, S., Musengimana, G., and Nsanzimana, S. (2020). Patient and healthcare provider experiences of hepatitis C treatment with di-rect-acting antivirals in Rwanda: A qualitative exploration of barriers and facilitators. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09000-0"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugpo.2019.07.016","article-title":"Elimination of hepatitis C virus infection among people who use drugs: Ensuring equitable access to prevention, treatment, and care for all","volume":"72","author":"Grebely","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1038\/s41575-022-00645-3","article-title":"Hepatitis C testing, treatment and prevention in low- and middle-income country prisons","volume":"19","author":"Tucker","year":"2022","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12954-021-00580-7","article-title":"Barriers and facilitators of HIV and hepatitis C care among people who inject drugs in Nairobi, Kenya: A qualitative study with peer educators","volume":"18","author":"Guthrie","year":"2021","journal-title":"Harm. Reduct. J."},{"key":"ref_20","unstructured":"Ministry of Health and Child Care Zimbabwe (2019). Strategic Plan for the Control and Elimination of Viral Hepatitis in Zimbabwe 2019\u20132025."},{"key":"ref_21","unstructured":"Government of Zimbabwe (2020). 8th Essential Medicines List and Standard Treatment Guidelines for Zimbabwe."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Bishai, D., Brenzel, L., and Padula, W. (2023). Reporting and interpreting results of economic evaluation. Handbook of Applied Health Economics in Vaccines, Oxford Academic. Handbooks in Health Economic Evaluation.","DOI":"10.1093\/oso\/9780192896087.001.0001"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/heapol\/czac093","article-title":"Exploring the roles of players in strategic purchasing for healthcare in Africa\u2014A scoping review","volume":"38","author":"Kachapila","year":"2023","journal-title":"Health Policy Plan."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1178632919837629","DOI":"10.1177\/1178632919837629","article-title":"Components Affecting Pharmaceutical Strategic Purchasing: A Scoping Review","volume":"12","author":"Bastani","year":"2019","journal-title":"Health Serv. Insights"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Scheibe, A., Young, K., Versfeld, A., Spearman, C.W., Sonderup, M.W., Prabdial-Sing, N., Puren, A., and Hausler, H. (2020). Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa: Findings from a seven-city cross-sectional survey (2017). BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05359-y"},{"key":"ref_26","unstructured":"Zimbabwe National Statistics Agency (2022). Zimbabwe Population and Housing Census."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/QAI.0000000000002393","article-title":"Estimating the Population Size of Female Sex Workers in Zimbabwe: Comparison of Estimates Obtained Using Different Methods in Twenty Sites and Development of a National-Level Estimate","volume":"85","author":"Fearon","year":"2020","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_28","unstructured":"(2024, August 26). Population Size Estimates for People Who Inject Drugs. Harm Reduction International. Available online: https:\/\/hri.global\/special\/population-size-estimates-for-people-who-inject-drugs\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1080\/23744235.2024.2351045","article-title":"Prevalence and trends of hepatitis B and C virus biomarkers in Zimbabwe: Comparative analyses of a nation\u2019s blood-donor surveillance data and meta-analyses of population studies","volume":"56","author":"Mabaya","year":"2024","journal-title":"Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e004181","DOI":"10.1136\/bmjgh-2020-004181","article-title":"Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar","volume":"6","author":"Marquez","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_31","unstructured":"(2024, October 02). Life Tables: Life Tables by Country Zimbabwe. Available online: https:\/\/apps.who.int\/gho\/data\/view.searo.61860?lang=en."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.gtc.2015.07.003","article-title":"Natural History of Hepatitis C","volume":"44","author":"Lingala","year":"2015","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Boyer, S., Baudoin, M., Nishimwe, M.L., Santos, M., Lemoine, M., Maradan, G., Sylla, B., Kouanfack, C., Carrieri, P., and Mourad, A. (2022). Cost-utility analysis of four WHO-recommended sofosbuvir-based regimens for the treatment of chronic hepatitis C in sub-Saharan Africa. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-021-07289-0"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101000","DOI":"10.1016\/j.jhepr.2024.101000","article-title":"Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis","volume":"6","author":"Zhou","year":"2024","journal-title":"JHEP Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3350\/cmh.2021.0236","article-title":"A cost-effectiveness study of universal screening for hepatitis C virus infection in South Korea: A societal perspective","volume":"28","author":"Kim","year":"2022","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e31183","DOI":"10.1097\/MD.0000000000031183","article-title":"Safety and efficacy of sofosbuvir-velpatasvir: A meta-analysis","volume":"101","author":"Ren","year":"2022","journal-title":"Medicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e027491","DOI":"10.1136\/bmjopen-2018-027491","article-title":"Estimation of fibrosis progression rates for chronic hepatitis C: A systematic review and meta-analysis update","volume":"9","author":"Erman","year":"2019","journal-title":"BMJ Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2165\/00019053-200725010-00002","article-title":"Rates and probabilities in economic modelling: Transformation, translation and appropriate application","volume":"25","author":"Fleurence","year":"2007","journal-title":"Pharmacoeconomics"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Gobran, S.T., Ancuta, P., and Shoukry, N.H. (2021). A Tale of Two Viruses: Immunological Insights Into HCV\/HIV Coinfection. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.726419"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1097\/QAD.0b013e32830e6d51","article-title":"Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: A meta-analysis","volume":"22","author":"Thein","year":"2008","journal-title":"AIDS"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"100665","DOI":"10.1016\/j.jhepr.2022.100665","article-title":"Patient-reported outcomes with direct-acting antiviral treatment for hepatitis C in West and Central Africa (TAC ANRS 12311 trial)","volume":"5","author":"Marcellin","year":"2023","journal-title":"JHEP Rep."},{"key":"ref_42","unstructured":"(2024, May 27). World Bank Open Data. Available online: https:\/\/data.worldbank.org."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.jval.2016.02.017","article-title":"Country-Level Cost-Effectiveness Thresholds: Initial Estimates and the Need for Further Research","volume":"19","author":"Woods","year":"2016","journal-title":"Value Health"},{"key":"ref_44","unstructured":"Clinton Health Access Initiative (CHAI) (2021). HCV Market Intelligence Report 2021 and Preliminary HBV Market Insights, CHAI."},{"key":"ref_45","unstructured":"(2024, August 06). Global Cancer Observatory Factsheet, Zimbabwe. Available online: https:\/\/gco.iarc.who.int\/media\/globocan\/factsheets\/populations\/716-zimbabwe-fact-sheet.pdf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1750-9378-4-15","article-title":"Seroprevalence of HBV and HCV in primary hepatocellular carcinoma patients in Zimbabwe","volume":"4","author":"Chavhunduka","year":"2009","journal-title":"Infect. Agents Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/jvh.13422","article-title":"Cost-effectiveness of screening and treatment using direct-acting antivirals for chronic Hepatitis C virus in a primary care setting in Karachi, Pakistan","volume":"28","author":"Mafirakureva","year":"2021","journal-title":"J. Viral Hepat."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Wu, M., Ma, J., Wang, X., Li, S., Tan, C., Xie, O., Li, A., Lim, A.G., and Wan, X. (2024). Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study. Clin. Mol. Hepatol.","DOI":"10.3350\/cmh.2024.0664"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/S2468-1253(20)30010-8","article-title":"Global hepatitis C elimination: An investment framework","volume":"5","author":"Pedrana","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/S2468-1253(20)30008-X","article-title":"A model of the economic benefits of global hepatitis C elimination: An investment case","volume":"5","author":"Scott","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s40265-016-0684-y","article-title":"Eight- or 12-Week Treatment of Hepatitis C with Ledipasvir\/Sofosbuvir: Real-World Experience in a Large Integrated Health System","volume":"77","author":"Lai","year":"2017","journal-title":"Drugs"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4759","DOI":"10.3748\/wjg.v23.i26.4759","article-title":"Eight-week ledipasvir\/sofosbuvir in non-cirrhotic, treatment-na\u00efve hepatitis C genotype-1 patients with hepatitis C virus-RNA < 6 million: Single center, real world effectiveness and safety","volume":"23","author":"Latt","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3480","DOI":"10.1007\/s10620-018-5283-1","article-title":"Eight-Week Hepatitis C Treatment with New Direct Acting Antivirals Has a Better Safety Profile While Being Effective in the Treatment-Na\u00efve Geriatric Population Without Liver Cirrhosis and Hepatitis C Virus-RNA < 6 Million IU\/mL","volume":"63","author":"Yanny","year":"2018","journal-title":"Dig. Dis. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s12985-024-02544-2","article-title":"Efficacy of 8-week daclatasvir-sofosbuvir regimen in chronic hepatitis C: A systematic review and meta-analysis","volume":"21","author":"Farrag","year":"2024","journal-title":"Virol. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1358\/dot.2018.54.7.2828188","article-title":"Glecaprevir\/pibrentasvir for the treatment of chronic hepatitis C virus infection in adults","volume":"54","author":"Nehra","year":"2018","journal-title":"Drugs Today"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/liv.15123","article-title":"Cost-effectiveness analysis of hepatitis C virus (HCV) point-of-care assay for HCV screening","volume":"42","author":"Koo","year":"2022","journal-title":"Liver Int."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/14737167.2024.2348053","article-title":"Cost effectiveness of hepatitis C direct acting agents","volume":"24","author":"Shetty","year":"2024","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e1424","DOI":"10.1016\/S2214-109X(24)00235-3","article-title":"A risk-differentiated, community-led intervention to strengthen uptake and engagement with HIV prevention and care cascades among female sex workers in Zimbabwe (AMETHIST): A cluster randomised trial","volume":"12","author":"Cowan","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e417","DOI":"10.1016\/S2352-3018(18)30111-5","article-title":"Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): A cluster-randomised trial","volume":"5","author":"Cowan","year":"2018","journal-title":"Lancet HIV"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/hec.3319","article-title":"Foreword: Health Economic Evaluations in Low- and Middle-income Countries: Methodological Issues and Challenges for Priority Setting","volume":"25","author":"Pitt","year":"2016","journal-title":"Health Econ."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/heapol\/czw096","article-title":"Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds","volume":"32","author":"Robinson","year":"2017","journal-title":"Health Policy Plan."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"176","DOI":"10.12688\/gatesopenres.13201.1","article-title":"What next after GDP-based cost-effectiveness thresholds?","volume":"4","author":"Chi","year":"2020","journal-title":"Gates Open Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1093\/heapol\/czz152","article-title":"Estimating a cost-effectiveness threshold for health care decision-making in South Africa","volume":"35","author":"Edoka","year":"2020","journal-title":"Health Policy Plan."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1478-7547-6-14","article-title":"Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease","volume":"6","author":"Hansen","year":"2008","journal-title":"Cost Eff. Resour. Alloc."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Tang, W., Chen, W., Amini, A., Boeras, D., Falconer, J., Kelly, H., Peeling, R., Varsaneux, O., Tucker, J.D., and Easterbrook, P. (2020). Diagnostic accuracy of tests to detect Hepatitis C antibody: A meta-analysis and review of the literature. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2773-2"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"112","DOI":"10.7196\/SAMJ.2020.v110i2.14195","article-title":"Direct-acting antiviral therapy for hepatitis C: The initial experience of the University of Cape Town\/Groote Schuur Hospital Liver Clinic, South Africa","volume":"110","author":"Sonderup","year":"2020","journal-title":"S. Afr. Med. J."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/509\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:02:55Z","timestamp":1760029375000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":66,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ijerph22040509"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22040509","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]}}}