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

Josephine G Walker*, Nyashadzaishe Mafirakureva, Momoko Iwamoto, Linda S Campbell, Chamroeun San Kim, Reuben Hastings, Jean-Philippe Doussett, Mickael Le Paih, Suna Balkan, Tonia Marquardt, David Maman, Anne Lorec, Joanna Coast, Peter T Vickerman

*Corresponding author for this work

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Abstract

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.
Original languageEnglish
Number of pages11
JournalLiver International
Early online date31 May 2020
DOIs
Publication statusE-pub ahead of print - 31 May 2020

Keywords

  • cost‐effectiveness
  • direct‐acting antiviral treatment
  • healthcare costs
  • hepatitis C
  • low‐income population
  • Markov process
  • treatment costs

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    Walker, J. G., Mafirakureva, N., Iwamoto, M., Campbell, L. S., San Kim, C., Hastings, R., Doussett, J-P., Le Paih, M., Balkan, S., Marquardt, T., Maman, D., Lorec, A., Coast, J., & Vickerman, P. T. (2020). Cost and cost-effectiveness of a simplified treatment model with direct-acting antivirals for chronic hepatitis C in Cambodia. Liver International. https://doi.org/10.1111/liv.14550