en
Scientific article
Open access
English

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

Published inBMJ global health, vol. 6, no. 2, e004181
Publication date2021-02
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.

eng
Keywords
  • HIV
  • Health economics
  • Viral hepatitis
  • 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
Citation (ISO format)
MARQUEZ, Lara K et al. Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar. In: BMJ global health, 2021, vol. 6, n° 2, p. e004181. doi: 10.1136/bmjgh-2020-004181
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Article (Published version)
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ISSN of the journal2059-7908
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