缅甸 HIV 感染者真实世界 HCV 治疗方案的成本和成本效益。
Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar.
机构信息
Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
School of Public Health, San Diego State University, San Diego, California, USA.
出版信息
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-004181.
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.
简介
超过一半的丙型肝炎病毒（HCV）/艾滋病毒合并感染患者生活在中低收入国家，许多人未被诊断或未得到治疗。2016 年，无国界医生组织（MSF）在缅甸为 HCV/HIV 合并感染人群建立了直接作用抗病毒（DAA）治疗方案。我们的研究目的是评估该方案的实际成本和成本效益，并评估如果由卫生部（MoH）实施该方案的潜在成本效益。
方法
从缅甸岱维的 MSF 前瞻性队列研究中收集了成本（患者层面的微观成本）和治疗结果。使用马尔可夫模型从卫生提供者的角度评估该方案与不进行 HCV 治疗的成本效益。估计终生和医疗保健成本（2017 年以美元计）和健康结果（以残疾调整生命年（DALYs）计），以计算增量成本效益比（ICER），与缅甸人均国内生产总值（GDP）的支付意愿阈值（1250 美元）进行比较。我们评估了使用经过质量保证的通用 DAA 价格更新后的成本效益，以及如果由 MoH 实施简化治疗方案的潜在成本效益。
结果
从 2016 年 11 月至 2017 年 10 月，122 名 HIV/HCV 合并感染患者接受了 DAA 治疗（46%患有肝硬化），96%（n=117）实现了持续病毒学应答。平均治疗费用为 1229 美元（无肝硬化）和 1971 美元（肝硬化），DAA 药物是成本的最大贡献者。与不治疗相比，该方案具有成本效益（ICER 为每避免 1 个残疾调整生命年（DALY）634 美元）；使用经过质量保证的通用 DAA 价格更新后的方案具有更高的成本效益（ICER 为每避免 1 个 DALY 488 美元）。如果简化治疗方案由 MoH 实施，并能取得类似的结果，那么该方案可能具有成本效益（ICER 为每避免 1 个 DALY 316 美元）。
结论
使用 MSF 方案数据，针对 HIV 合并感染个体的 HCV 的 DAA 治疗方案在缅甸具有成本效益，并且使用经过质量保证的通用 DAA 价格更新后的方案更具成本效益。如果进一步推广证明其不会导致治疗结果恶化，则简化治疗方案可以提高成本效益。
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