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. 2020 Nov;40(11):2643-2654.
doi: 10.1111/liv.14613. Epub 2020 Aug 31.

Long-term clinical benefits of Sofosbuvir-based direct antiviral regimens for patients with chronic hepatitis C in Central and West Africa

Mael Baudoin  1 , Maame E Woode  2 , Marie Libérée Nishimwe  1 , Maud Lemoine  3 , Babacar Sylla  4 , Charles Kouanfack  5   6 , Raoul Moh  7   8 , Moussa Seydi  9 , Nicolas Rouveau  10 , Alain Attia  11 , Karine Lacombe  12   13 , Sylvie Boyer  1
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Free article

Long-term clinical benefits of Sofosbuvir-based direct antiviral regimens for patients with chronic hepatitis C in Central and West Africa

Mael Baudoin et al. Liver Int. 2020 Nov.
Free article

Abstract

Background: In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Côte d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct-acting antiviral (DAAs) effectiveness in West and Central Africa.

Methods: Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n = 3224), Côte d'Ivoire (n = 9748) and Senegal (n = 6358). Lifetime treatment benefits were assessed using (a) life-years saved (LYS); (b) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma; and (c) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty.

Results: Sofosbuvir-based treatment would save [mean, 95% confidence intervals] 3.3 (2.5; 5.7) LY per patient in Cameroon, 2.7 (2.1; 4.8) in Côte d'Ivoire and 3.6 (2.8; 6.3) in Senegal. With treatment, approximately 6% (1%) of the patients still alive in each of the study countries would be in the CC (DC) health state 11 (15) years after CHC diagnosis, vs 15% (5%) without treatment. Scenario analysis showed earlier diagnosis and treatment initiation would dramatically improve LYS and morbidity.

Conclusion: Sofosbuvir-based treatment could significantly reduce CHC-related mortality and help control CHC-related liver disease progression in West and Central Africa. However, the goal of disease elimination necessitates a substantial decrease in DAAs prices, greater political commitment and increases in both national and external health expenditures.

Keywords: Africa; Markov simulation; direct-acting antivirals (DAAs); hepatitis C; low-income countries.

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References

REFERENCES

    1. WHO. WHO. Global hepatitis report, 2017. WHO. http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/. Accessed February 19, 2020
    1. Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161-176.
    1. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61(1 Suppl):S58-S68.
    1. Nahon P, Layese R, Bourcier V, et al, Incidence of hepatocellular carcinoma after direct antiviral therapy for HCV in patients with cirrhosis included in surveillance programs. Gastroenterology. 2018;155(5):1436-1450.e6.
    1. Lemoine M, Thursz MR. Battlefield against hepatitis B infection and HCC in Africa. J Hepatol. 2017;66(3):645-654.

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