Walker Josephine G, Mafirakureva Nyashadzaishe, Iwamoto Momoko, Campbell Linda, Kim Chamroeun San, Hastings Reuben A, Doussett Jean-Philippe, Le Paih Mickael, Balkan Suna, Marquardt Tonia, Maman David, Loarec Anne, Coast Joanna, Vickerman Peter
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.
Epicentre, Paris, France.
Liver Int. 2020 Oct;40(10):2356-2366. doi: 10.1111/liv.14550. Epub 2020 Jun 21.
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.
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).
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.
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.
2016年，无国界医生组织在柬埔寨设立了首个普通人群丙型肝炎病毒（HCV）筛查与治疗点，提供免费的直接抗病毒药物（DAA）治疗。本研究分析了该干预措施的成本效益。
采用马尔可夫模型在终身范围内预测干预措施的成本、质量调整生命年（QALY）和成本效益，贴现率为每年3%。从一项观察性队列研究中收集患者层面的资源使用和结局数据、治疗成本、HCV相关医疗保健成本以及EQ-5D-5L健康状态，该研究评估了与不治疗相比，在全面和简化护理模式下DAA治疗的有效性；其他模型参数来自文献。将增量成本效益比（成本/QALY获得量）与基于机会成本的柬埔寨支付意愿阈值（248美元/QALY）进行比较。
全面护理模式下每位患者的检测和治疗总成本为925美元（四分位间距668 - 1631美元），简化护理模式下降至376美元（四分位间距344 - 422美元）。EQ-5D-5L值因纤维化阶段而异：失代偿期肝硬化的值最低，在治疗期间及之后值会增加。与不治疗相比，简化护理模式节省成本，而全面护理模式虽然与不治疗相比具有成本效益（187美元/QALY），但与简化模式相比，每QALY额外花费14485美元，高于柬埔寨的支付意愿阈值。该结果对参数变化具有稳健性。
与不治疗相比，简化护理模式节省成本，强调了简化护理途径对于在资源匮乏地区改善HCV治疗可及性的重要性。
