Journal
BMJ GLOBAL HEALTH
Volume 6, Issue 2, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjgh-2020-004181
Keywords
health economics; HIV; viral hepatitis
Categories
Funding
- UNITAID [SPHQ14-LOA -217]
- National Institute of Drug Abuse (NIDA), National Institutes of Health (NIH) [T32 DA023356]
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol
- Public Health England (PHE)
- NIAID
- NIDA [R01AI147490]
- University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) [P30 AI036214]
- NCI
- NIMH
- NIDA
- NICHD
- NHLBI
- NIA
- NIGMS
- NIDDK
Ask authors/readers for more resources
The study evaluated the cost-effectiveness of an MSF DAA treatment program for HIV/HCV coinfected patients in Myanmar, showing that the program is cost-effective compared to no treatment, especially with updated prices for quality-assured generic DAAs. Implementing a simplified treatment protocol by the MoH could also be cost-effective, if associated with similar outcomes.
Introduction Over half of those hepatitis C virus (HCV)/HIV coinfected live in low-income and middle-income countries, and many remain undiagnosed or untreated. In 2016, Medecins Sans Frontieres (MSF) established a direct-acting antiviral (DAA) treatment programme for people HCV/HIV coinfected in Myanmar. The purpose of our study was to evaluate the real-world cost and cost-effectiveness of this programme, and potential cost-effectiveness if implemented by the Ministry of Health (MoH). Methods Costs (patient-level microcosting) and treatment outcomes were collected from the MSF prospective cohort study in Dawei, Myanmar. A Markov model was used to assess cost-effectiveness of the programme compared with no HCV treatment from a health provider perspective. Estimated lifetime and healthcare costs (in 2017 US$) and health outcomes (in disability-adjusted life-years (DALYs)) were simulated to calculate the incremental cost-effectiveness ratio (ICER), compared with a willingness-to-pay threshold of per capita Gross Domestic Product in Myanmar ($1250). We evaluated cost-effectiveness with updated quality-assured generic DAA prices and potential cost-effectiveness of a proposed simplified treatment protocol with updated DAA prices if implemented by the MoH. Results From November 2016 to October 2017, 122 with HIV/HCV-coinfected patients were treated with DAAs (46% with cirrhosis), 96% (n=117) achieved sustained virological response. Mean treatment costs were $1229 (without cirrhosis) and $1971 (with cirrhosis), with DAA drugs being the largest contributor to cost. Compared with no treatment, the program was cost-effective (ICER $634/DALY averted); more so with updated prices for quality-assured generic DAAs (ICER $488/DALY averted). A simplified treatment protocol delivered by the MoH could be cost-effective if associated with similar outcomes (ICER $316/DALY averted). Conclusions Using MSF programme data, the DAA treatment programme for HCV among HIV-coinfected individuals is cost-effective in Myanmar, and even more so with updated DAA prices. A simplified treatment protocol could enhance cost-effectiveness if further rollout demonstrates it is not associated with worse treatment outcomes.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available