A small-scale Development Impact Bond for hepatitis C diagnosis and treatment in Cameroon: the way to elimination?

In the absence of sufficient (tax-based) healthcare financing in low-and middle-income countries, innovative financing models are needed. This study assessed quantitatively and qualitative the feasibility of a Development Impact Bond (DIB) for hepatitis C Virus (HCV) diagnosis and treatment in Cameroon. A revolving fund of up to €230,000 was made available by the investor. The outcome payor repaid the investor only in case of good performance, defined as cured patients (HCV-RNA negative). Identified HCV carriers were referred for treatment and tested for cure 12 weeks after completion of treatment, the outcome being validated by an independent party. The evaluation was guided by a recognized framework, involving interviews with relevant stakeholders (N= 22). In total, 253 (98%) patients completed treatment of which 244 (96%) are cured at week 24. We estimated that the average per patient outcome payment for HCV diagnosis and treatment is €1,542 and the average costs per treated patient is €1,858. The investor was fully repaid including the agreed interest and bonus rate. The interviews confirmed the feasibility of the DIB in a low-resource setting. This study demonstrates that a DIB can be a suitable financing mechanism for HCV services, supporting the path towards elimination. When governments do not have sufficient resources to fund such elimination programs upfront, such public-private partnerships can offer a solution. Highlights The availability of a short-course highly effective hepatitis C treatment paves the way towards its elimination. We demonstrate feasibility of the first Development Impact Bond (DIB) as a financing mechanism for hepatitis C diagnosis and treatment. This study shows that with an average per patient outcome payment of €1,542, one HCV patient can be diagnosed and treated in a lower-middle income country.