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    Jan 17, 2021
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    Cost and cost-effectiveness of a simplified treatment model with direct-acting antivirals for chronic hepatitis C in Cambodia

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    Name:
    Walker et al 2020 Cost and ...
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    Authors
    Walker, JG
    Mafirakureva, N
    Iwamoto, M
    Campbell, L
    Kim, CS
    Hastings, RA
    Doussett, JP
    Le Paih, M
    Balkan, S
    Marquardt, T
    Maman, D
    Loarec, A
    Coast, J
    Vickerman, P
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    Issue Date
    2020-05-31
    Submitted date
    2020-07-10
    
    Metadata
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    Journal
    Liver International
    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 $668-1631), 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. Keywords: Markov process; cost-effectiveness; direct-acting antiviral treatment; healthcare costs; hepatitis C; low-income population; treatment costs.
    Publisher
    Wiley
    URI
    http://hdl.handle.net/10144/619676
    DOI
    10.1111/liv.14550
    PubMed ID
    32475010
    Type
    Article
    Language
    en
    EISSN
    1478-3231
    ae974a485f413a2113503eed53cd6c53
    10.1111/liv.14550
    Scopus Count
    Collections
    Other Diseases

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