Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar

Lara K Marquez; Antoine Chaillon; Kyi Pyar Soe; Derek C Johnson; Jean-Marc Zosso; Andrea Incerti; Anne Loarec; Aude Nguyen; Josephine G Walker; Nyashadzaishe Mafirakureva; Vincent Lo Re Iii; Adriane Wynn; Craig McIntosh; Susan M Kiene; Stephanie Brodine; Richard S Garfein; Peter Vickerman; Natasha K Martin

doi:10.1136/bmjgh-2020-004181

Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar

BMJ Glob Health. 2021 Feb;6(2):e004181. doi: 10.1136/bmjgh-2020-004181.

Authors

Lara K Marquez^{1

2}, Antoine Chaillon³, Kyi Pyar Soe⁴, Derek C Johnson⁵, Jean-Marc Zosso⁶, Andrea Incerti⁷, Anne Loarec⁸, Aude Nguyen^{7

9}, Josephine G Walker¹⁰, Nyashadzaishe Mafirakureva¹⁰, Vincent Lo Re Iii¹¹, Adriane Wynn³, Craig McIntosh¹², Susan M Kiene², Stephanie Brodine², Richard S Garfein¹³, Peter Vickerman¹⁰, Natasha K Martin³

Affiliations

¹ Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA lkusnezo@health.ucsd.edu.
² School of Public Health, San Diego State University, San Diego, California, USA.
³ Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA.
⁴ Medical Department, Dawei Project, Doctors Without Borders, Dawei, Myanmar.
⁵ Medical Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar.
⁶ Finance Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar.
⁷ Medical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland.
⁸ Epidemiology, Epicentre, Paris, Île-de-France, France.
⁹ Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
¹⁰ Population Health Sciences, University of Bristol, Bristol, UK.
¹¹ Division of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹² School of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA.
¹³ Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.

Abstract

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, Médecins Sans Frontières (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.

Keywords: HIV; health economics; viral hepatitis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Antiviral Agents / therapeutic use
Cost-Benefit Analysis
HIV Infections* / complications
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Hepacivirus
Hepatitis C* / complications
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Hepatitis C, Chronic* / drug therapy
Humans
Myanmar / epidemiology
Prospective Studies

Substances

Antiviral Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding