Naomi Ferguson
Medical Officer, Seychelles
Title: Cost-effectiveness of treating hepatitis C in Seychelles with direct-acting antivirals as compared to no treatment
Biography
Biography: Naomi Ferguson
Abstract
Background & Aim: Approximately 80 million people around the world are living with hepatitis C, and 700,000 people die every year from hepatitis C related complications. Since 2014, oral medications called Directly-Acting Antivirals (DAAs) have been available for curative treatment. In Seychelles, a total of 777 cases of hepatitis C were reported from 2002 to 2016, but up to mid of 2016, the cases were not being treated. Treatment with DAA Harvoni, a combination of Sofosbuvir and Ledipasvir (SOF/LDV), is now being offered conditionally to those at low risk of re-infection. The aim of this study is to establish cost effectiveness of treating all cases of hepatitis C in Seychelles with Harvoni, as compared to no treatment.
Methods: A systematic review was carried out, using MEDLINE, Embase and NHS-EED. Data was extracted from the identified studies, including author, year, title, country, population, intervention and comparators, method (time horizon, perspective, model, clinical data source, cost data source, outcome measures and discount rate), results and discussion. Evidence from the systematic review was used to populate an economic model to calculate cost-effectiveness from Seychelles’ Government perspective. The population characteristics were based on the HCV cohort data from Seychelles. The model structure was also informed by the systematic review and an accompanying grading of economic models using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. The economic model used was a Markov model, using a lifetime horizon and taking a payer’s perspective. Costs were discounted at 3% per annum. Outcome measures included Quality Adjusted Life Years (QALYs). Costs and QALYs were used to calculate Incremental Cost Effectiveness Ratios (ICERs).
Results: Harvoni, was found to be cost-saving in Seychelles HCV cohort, as compared to no treatment, with an ICER of €-753.65/QALY. The treatment was also cost-saving when stratified by gender, with the ICER of male and female being €-783.74/QALY and €-635.20/QALY, respectively. These findings were robust to probabilistic sensitivity analysis.
Conclusion: Treating hepatitis C cases in Seychelles is cost-saving. These results will help inform the policies on strategies to eliminate hepatitis C in Seychelles.