4.7 Article

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

期刊

LIVER INTERNATIONAL
卷 40, 期 10, 页码 2356-2366

出版社

WILEY
DOI: 10.1111/liv.14550

关键词

cost-effectiveness; direct-acting antiviral treatment; healthcare costs; hepatitis C; low-income population; Markov process; treatment costs

资金

  1. Unitaid [SPHQ14-LOA-217]
  2. Medecins Sans Frontieres
  3. NIHR HPRU in Evaluation of Interventions [IS-HPU-1112-10026]
  4. National Institutes of Health Research (NIHR) [IS-HPU-1112-10026] Funding Source: National Institutes of Health Research (NIHR)

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Background & Aims In 2016, Medecins Sans Frontieres 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 $668-1631), 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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