Cost and cost-effectiveness of a simplified treatment model with direct-acting antivirals for chronic hepatitis C in Cambodia.

Auteurs: Walker JG Mafirakureva N Iwamoto M Campbell L Kim CS Hastings RA Doussett JP Le Paih M Balkan S Marquardt T Maman D Loarec A Coast J Vickerman P
Référence de l'article: Liver international : official journal of the International Association for the Study of the Liver 2020 May 31; (); Array. doi: 10.1111/liv.14550. Epub 2020 05 31
Markov process cost effectiveness direct acting antiviral treatment healthcare costs hepatitis C low income population treatment costs


BACKGROUND & AIMS: In 2016, Médecins Sans Frontières established the first general population Hepatitis C virus (HCV) screening and treatment site in Cambodia, offering free direct acting antiviral (DAA) treatment. This study analysed the cost-effectiveness of this intervention.

METHODS: Costs, quality adjusted life years (QALYs) and cost-effectiveness of the intervention were projected with a Markov model over a lifetime horizon, discounted at 3%/year. Patient-level resource-use and outcome data, treatment costs, costs of HCV-related healthcare and EQ-5D-5L health states were collected from an observational cohort study evaluating the effectiveness of DAA treatment under full and simplified models of care compared to no treatment; other model parameters were derived from literature. Incremental cost-effectiveness ratios (cost/QALY gained) were compared to an opportunity cost-based willingness-to-pay threshold for Cambodia ($248/QALY).

RESULTS: The total cost of testing and treatment per patient for the full model of care was $925(IQR $668-1,631), reducing to $376(IQR $344-422) for the simplified model of care. EQ-5D-5L values varied by fibrosis stage: decompensated cirrhosis had the lowest value, values increased during and following treatment. The simplified model of care was cost saving compared to no treatment, while the full model of care, although cost-effective compared to no treatment ($187/QALY), cost an additional $14,485/QALY compared to the simplified model, above the willingness-to-pay threshold for Cambodia. This result is robust to variation in parameters.

CONCLUSIONS: The simplified model of care was cost saving compared to no treatment, emphasizing the importance of simplifying pathways of care for improving access to HCV treatment in low-resource settings.

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