Evidence map›Paper›PMID 33627360›Full record

ArticleBMJ global health2021

Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar.

Lara K Marquez, Antoine Chaillon, Kyi Pyar Soe, Derek C Johnson, Jean-Marc Zosso, Andrea Incerti, Anne Loarec, Aude Nguyen, Josephine G Walker, Nyashadzaishe Mafirakureva and 8 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.8field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Cost-Effectiveness of Screening and Treating Chronic Hepatitis C Virus Infection in Zimbabwe.International journal of environmental research and public health · 2025
    Article
  3. Article
  4. Observational
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 8 institutions in 4 countries.

Lara K MarquezDivision of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA lkusnezo@health.ucsd.edu.ORCID 0000-0003-0386-2936
Antoine ChaillonDivision of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA.
Kyi Pyar SoeMedical Department, Dawei Project, Doctors Without Borders, Dawei, Myanmar.
Derek C JohnsonMedical Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar.
Jean-Marc ZossoFinance Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar.
Andrea IncertiMedical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland.
Anne LoarecEpidemiology, Epicentre, Paris, Île-de-France, France.
Aude NguyenMedical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland.
Josephine G WalkerPopulation Health Sciences, University of Bristol, Bristol, UK.
Nyashadzaishe MafirakurevaPopulation Health Sciences, University of Bristol, Bristol, UK.ORCID 0000-0001-9775-6581
Vincent Lo Re IiiDivision of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Adriane WynnDivision of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA.
Craig McIntoshSchool of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA.
Susan M KieneSchool of Public Health, San Diego State University, San Diego, California, USA.
Stephanie BrodineSchool of Public Health, San Diego State University, San Diego, California, USA.
Richard S GarfeinDepartment of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
Peter VickermanPopulation Health Sciences, University of Bristol, Bristol, UK.
Natasha K MartinDivision of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA.
University of California San Diego · USSan Diego State University · USUniversity of Bristol · GBMyanmar Oxford Clinical Research Unit · MMMédecins Sans Frontières · CHTechnological University Dawei · MMUniversity Hospital of Geneva · CHUniversity of Pennsylvania · US

Funding

VirologyP30AI036214 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI SUSAN JANET LITTLE · 1994 to 2026
$78.4M
Training Program in Substance Use, HIV and Related InfectionsT32DA023356 · NIDA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Natasha Martin, Steffanie A Strathdee · 2007 to 2026
$7.8M
Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modelingR01AI147490 · NIAID · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MARTIN, NATASHA · 2019 to 2022
$2.3M
Modeling reductions in harmful alcohol use on HIV transmission and mortality in the era of universal test and treat in UgandaK01AA027733 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI WYNN, ADRIANE MICHELLE · 2020 to 2024
$888k
NIAAA NIH HHS K01 AA027733NIAID NIH HHS P30 AI036214NIAID NIH HHS R01 AI147490NIDA NIH HHS T32 DA023356
6 · The paper itself

Abstract

introductionOver 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).

methodsCosts (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.

resultsFrom 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).

conclusionsUsing 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.

Indexed as

Hepatitis CHepatitis C, ChronicHIV InfectionsAntiviral AgentsCost-Benefit AnalysisHepacivirusHumansMyanmarProspective StudiesAntiviral Agentshealth economicsHIVviral hepatitis

Identifiers

PMID33627360
PMCPMC7908309
OpenAlexW3127303956

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.