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

Mafirakureva, Nyashadzaishe; Lim, Aaron G.; Khalid, Gul Ghuttai; Aslam, Khawar; Campbell, Linda; Zahid, Hassaan; Bergh, Rafaël Van den; Falq, Grégoire; Fortas, Camille; Wailly, Yves; Auat, Rosa; Donchuk, Dmytro; Loarec, Anne; Coast, Joanna; Vickerman, Peter; Walker, Josephine G.

doi:10.1111/jvh.13422

Cited by 13 publications

(11 citation statements)

References 43 publications

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“…Subnational studies in various LMICs have shown DAA treatment of HCV-diagnosed patients to be cost-effective in Myanmar [ 47 ] and cost-saving in India, Thailand, and South Africa, but they did not include screening costs [ 48 ]. Other subnational studies in Egypt [ 49 ], Cambodia [ 6 ], and Pakistan [ 21 ] have shown that screening and DAA treatment can be cost-effective or possibly cost-saving when compared to no screening and treatment. Besides these and our previous analyses [ 14 ], only one other analysis has evaluated the costs of undertaking a national scale-up of treatment to achieve the WHO HCV elimination targets.…”

Section: Discussionmentioning

confidence: 99%

“…Costs arising from screening and treatment, offset by healthcare management savings (compared with status quo), are designated as direct costs. Within the baseline model, the costs of HCV screening and treatment ( Table 1 ), inclusive of test kit costs, drug costs, staff time, and overheads were derived from a patient-level costing analysis [ 14 , 21 ] of a HCV treatment programme implemented by Médecins Sans Frontières (MSF) together with the local nongovernmental organisation SINA in Machar Colony, Karachi, over 2016 to 2017 [ 22 , 23 ] The annual healthcare costs of managing HCV-related disease (other than curative HCV treatment) for each HCV disease progression stage were also derived in this costing analysis ( Table 1 ) [ 14 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

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Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

et al. 2021

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Background Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included. Methods and findings We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare management to the economic productivity gains from reduced HCV-attributable absenteeism, presenteeism, and premature deaths. We also calculate the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for HCV elimination versus maintaining current levels of HCV treatment. This is compared to an opportunity cost-based willingness-to-pay threshold for Pakistan (US$148 to US$198/DALY). Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95% uncertainty interval (UI) 3.80 to 8.22) million DALYs and 333,000 (219,000 to 509,000) HCV-related deaths over 2018 to 2030. If HCV testing is partially integrated, this scale-up requires an investment of US$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV. Conclusions Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

et al. 2021

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“…Other HCV-related economic evaluation studies with relevance to Pakistan did not assess the cost-effectiveness of a comprehensive array of HCV diagnostic testing approaches. 15,[44][45][46] The WHO has set an ambitious goal that would require the diagnosis of 90% of all patients with HCV and treatment initiation for 80% of eligible patients with HCV by the year 2030. 8 Other targets include a 90% reduction in incident cases and a 65% reduction in HCV-associated mortality.…”

Section: Discussionmentioning

confidence: 99%

Assessing the potential cost-effectiveness of centralized vs point-of-care testing for hepatitis C virus in Pakistan: a model-based comparison

Babigumira

Karichu

Clark

et al. 2022

Preprint

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Background Pakistan has a hepatitis C virus (HCV) infection prevalence of 6-9% and aims to achieve World Health Organization (WHO) targets for elimination of HCV by the year 2030 through scaling HCV diagnosis and accelerating access to care. The clinical and economic benefits of various HCV testing strategies have not yet been evaluated in Pakistan. Objective To evaluate the potential cost-effectiveness of a reference laboratory-based (CEN) confirmatory testing approach vs a molecular near-patient point-of-care (POC) confirmatory approach to screen the general population for HCV in Pakistan. Methods We developed a decision-analytic model comparing HCV testing under two scenarios: screening with an anti-HCV antibody test (Anti-HCV) followed by either POC nucleic acid testing (NAT) (Anti-HCV-POC), or reference laboratory NAT (Anti-HCV-CEN), using data from published literature, the Pakistan Ministry of Health, and expert judgment. Outcome measures included: number of HCV infections identified per year, percentage of individuals correctly classified, total costs, average costs per individual tested, and cost-effectiveness. Sensitivity analysis was also performed. Results At a national level for a tested population of 25 million, the Anti-HCV-CEN strategy would identify 142,406 more HCV infections in one year and increase correct classification of individuals by 0.57% compared with the Anti-HCV-POC strategy. The total annual cost of HCV testing was reduced using the Anti-HCV-CEN strategy by $7.68 million ($0.31 per person). Thus, incrementally, the Anti-HCV-CEN strategy costs less and identifies more HCV infections than Anti-HCV-POC. Conclusions Anti-HCV-CEN would provide the best value for money when scaling up HCV testing in Pakistan.

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“… 25 , 26 To estimate disability-adjusted life years (DALYs), the disability weight from the 2013 Global Burden of Disease Study 27 was applied to the HIV disease state in the model as in previous studies. 28 We assumed that patients in the healthy state were free of disability.…”

Section: Methodsmentioning

confidence: 99%

Cost Utility of Supporting Family-Based Care to Prevent HIV and Deaths among Orphaned and Separated Children in East Africa: A Markov Model–Based Simulation

Wilson-Barthes

Braitstein

DeLong

et al. 2022

MDM Policy & Practice

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Purpose. Strengthening family-based care is a key policy response to the more than 15 million orphaned and separated children who have lost 1 or both parents in sub-Saharan Africa. This analysis estimated the cost-effectiveness of family-based care environments for preventing HIV and death in this population. Design. We developed a time-homogeneous Markov model to simulate the incremental cost per disability-adjusted life year (DALY) averted by supporting family-based environments caring for orphaned and separated children in western Kenya. Model parameters were based on data from the longitudinal OSCAR’s Health and Well-Being Project and published literature. We used a societal perspective, annual cycle length, and 3% discount rate. Incremental cost-effectiveness ratios were simulated over 5- to 15-y horizons, comparing family-based settings to street-based “self-care.” Parameter uncertainty was addressed via deterministic and probabilistic sensitivity analyses. Results. Under base-case assumptions, family-based environments prevented 422 HIV infections and 298 deaths in a simulated cohort of 1,000 individuals over 10 y. Compared with street-based self-care, family-based care had an incremental cost of $2,528 per DALY averted (95% confidence interval [CI]: 1,798, 2,599) and $2,355 per quality-adjusted life year gained (95% CI: 1,667, 2,413). The probability of family-based care being highly cost-effective was >80% at a willingness-to-pay (WTP) threshold of $2,250/DALY averted. Households receiving government cash transfers had minimally higher cost-effectiveness ratios than households without cash transfers but were still cost-effective at a WTP threshold of twice Kenya’s GDP per capita. Conclusions. Compared with the status quo of street-based self-care, family-based environments offer a cost-effective approach for preventing HIV and death among orphaned children in lower-middle income countries. Decision makers should consider increasing resources to these environments in tandem with social protection programs. Highlights UNICEF and more than 200 other international organizations endorsed efforts to redirect services toward family-based care as part of the 2019 UN Resolution on the Rights of the Child; yet this study is one of the first to quantify the cost-effectiveness of family-based care environments serving some of the world’s most vulnerable children. This health economic modeling analysis found that family-based environments would prevent 422 HIV infections and 298 deaths in a cohort of 1,000 orphaned and separated children over a 10-y time horizon. Compared with street-based “self-care,” family-based care resulted in an incremental cost of $2,528 per DALY averted (95% CI: 1,798, 2,599) and $2,355 per quality-adjusted life year gained (95% CI: 1,667, 2,413) after 10 y. Annual per-child expenditures for children living in family-based care environments in sub-Saharan Africa could potentially be increased by at least 25% and remain highly cost-effective.

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

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 13 publications

References 43 publications

Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

Assessing the potential cost-effectiveness of centralized vs point-of-care testing for hepatitis C virus in Pakistan: a model-based comparison

Cost Utility of Supporting Family-Based Care to Prevent HIV and Deaths among Orphaned and Separated Children in East Africa: A Markov Model–Based Simulation

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