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

• Published in: BMJ global health Vol. 6; no. 2; p. e004181
• Main Authors: Marquez, Lara K, Chaillon, Antoine, Soe, Kyi Pyar, Johnson, Derek C, Zosso, Jean-Marc, Incerti, Andrea, Loarec, Anne, Nguyen, Aude, Walker, Josephine G, Mafirakureva, Nyashadzaishe, Lo Re III, Vincent, Wynn, Adriane, McIntosh, Craig, Kiene, Susan M, Brodine, Stephanie, Garfein, Richard S, Vickerman, Peter, Martin, Natasha K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2021; BMJ Publishing Group
• Subjects: Antiviral drugs; Capital costs; Clinical outcomes; Cost analysis; Cost control; Counseling; Global health; Health administration; Hepatitis; Hepatitis C; HIV; Human immunodeficiency virus; Infections; Laboratories; Liver cancer; Liver cirrhosis; Liver diseases; Markov chains; Medical equipment; Original Research; Patients; Performance evaluation; Pharmacy; Myanmar (Burma); HIV; viral hepatitis; health economics
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2020-004181

IntroductionOver 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).MethodsCosts (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.ResultsFrom 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).ConclusionsUsing 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.