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. 2021 Feb;28(2):268-278.
doi: 10.1111/jvh.13422. Epub 2020 Nov 4.

Cost-effectiveness of screening and treatment using direct-acting antivirals for chronic Hepatitis C virus in a primary care setting in Karachi, Pakistan

Nyashadzaishe Mafirakureva  1 , Aaron G Lim  1 , Gul Ghuttai Khalid  2 , Khawar Aslam  2 , Linda Campbell  1 , Hassaan Zahid  2 , Rafael Van den Bergh  3 , Gregoire Falq  4 , Camille Fortas  4 , Yves Wailly  3 , Rosa Auat  3 , Dmytro Donchuk  3 , Anne Loarec  4 , Joanna Coast  1 , Peter Vickerman  1   5 , Josephine G Walker  1
Affiliations

Cost-effectiveness of screening and treatment using direct-acting antivirals for chronic Hepatitis C virus in a primary care setting in Karachi, Pakistan

Nyashadzaishe Mafirakureva et al. J Viral Hepat. 2021 Feb.

Abstract

Despite the availability of effective direct-acting antiviral (DAA) treatments for Hepatitis C virus (HCV) infection, many people remain undiagnosed and untreated. We assessed the cost-effectiveness of a Médecins Sans Frontières (MSF) HCV screening and treatment programme within a primary health clinic in Karachi, Pakistan. A health state transition Markov model was developed to estimate the cost-effectiveness of the MSF programme. Programme cost and outcome data were analysed retrospectively. The incremental cost-effectiveness ratio (ICER) was calculated in terms of incremental cost (2016 US$) per disability-adjusted life year (DALY) averted from the provider's perspective over a lifetime horizon. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses (PSA). The ICER for implementing testing and treatment compared to no programme was US$450/DALY averted, with 100% of PSA runs falling below the per capita Gross Domestic Product threshold for cost-effective interventions for Pakistan (US$1,422). The ICER increased to US$532/DALY averted assuming national HCV seroprevalence (5.5% versus 33% observed in the intervention). If the cost of liver disease care was included (adapted from resource use data from Cambodia which has similar GDP to Pakistan), the ICER dropped to US$148/DALY, while it became cost-saving if a recently negotiated reduced drug cost of $75/treatment course was assumed (versus $282 in base-case) in addition to cost of liver disease care. In conclusion, screening and DAA treatment for HCV infection are expected to be highly cost-effective in Pakistan, supporting the expansion of similar screening and treatment programmes across Pakistan.

Keywords: Pakistan; chronic hepatitis C; cost-effectiveness; low-income population; treatment costs.

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Conflict of interest statement

PV has received unrestricted research grants from Gilead unrelated to this study and honoraria from Gilead and Abbvie. JGW has received a research grant from Gilead unrelated to this study. GGK, KA, YW, HZ, RVB, GF, RA, DD, CF and AL were employed by MSF and/or by Epicentre, an association created by MSF in 1986 to provide epidemiological expertise to underpin MSF operations. They participated in planning the study, carrying out the research and writing the report. The other authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic of Markov model showing how patients progress through infection and liver disease states. I, infected; T, on treatment; S, susceptible; F0, no fibrosis; F1, portal fibrosis without septa; F2, portal fibrosis with few septa; F3, numerous septa without cirrhosis; F4, compensated cirrhosis; DC, decompensated cirrhosis; HCC, hepatocellular carcinoma. Baseline mortality occurs according to cohort age (not shown in figure)
Figure 2
Figure 2
Flow chart for patients diagnosed with chronic HCV. Data available for 4764 individuals enrolled in the study as of 31 October 2018
Figure 3
Figure 3
The lifetime incidence of liver‐related complications following DAA‐based treatment compared to no treatment in the intervention cohort. DAA—direct‐acting antivirals. DC, decompensated cirrhosis; HCC, hepatocellular carcinoma. Error bars show one standard deviation
Figure 4
Figure 4
Tornado diagram for univariate scenario analyses showing the impact of changes in parameter values on the base case incremental cost‐effectiveness ratio (ICER = $450/DALY, represented by the solid vertical line)
See this image and copyright information in PMC

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