Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis
Summary: Background: Global elimination of hepatitis B virus (HBV) requires expanded uptake of antiviral therapy, potentially by simplifying testing algorithms, especially in resource-limited countries. We evaluated the effectiveness, cost-effectiveness, and budget impact of three strategies that d...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X23004679 |
| _version_ | 1797391768282464256 |
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| author | Liem B Luong Nguyen, PhD Maud Lemoine, ProfPhD Gibril Ndow, MD Zachary J Ward, PhD Timothy B Hallet, ProfPhD Umberto D’Alessandro, ProfPhD Mark Thursz, ProfMD Shevanthi Nayagam, PhD Yusuke Shimakawa, PhD |
| author_facet | Liem B Luong Nguyen, PhD Maud Lemoine, ProfPhD Gibril Ndow, MD Zachary J Ward, PhD Timothy B Hallet, ProfPhD Umberto D’Alessandro, ProfPhD Mark Thursz, ProfMD Shevanthi Nayagam, PhD Yusuke Shimakawa, PhD |
| author_sort | Liem B Luong Nguyen, PhD |
| collection | DOAJ |
| description | Summary: Background: Global elimination of hepatitis B virus (HBV) requires expanded uptake of antiviral therapy, potentially by simplifying testing algorithms, especially in resource-limited countries. We evaluated the effectiveness, cost-effectiveness, and budget impact of three strategies that determine eligibility for anti-HBV treatment, as compared with the WHO 2015 treatment eligibility criteria, in The Gambia. Methods: We developed a microsimulation model of natural history using data from the Prevention of Liver Fibrosis and Cancer in Africa programme (known as PROLIFICA) in The Gambia, for an HBV-infected cohort of individuals aged 20 years. The algorithms included in the model were a conventional strategy using the European Association for the Study of the Liver (EASL) 2017 criteria, a simplified algorithm using hepatitis B e antigen and alanine aminotransferase (the Treatment Eligibility in Africa for the Hepatitis B Virus [TREAT-B] score), a Treat All approach for all HBV-infected individuals, and the WHO 2015 criteria. Outcomes to measure effectiveness were disability-adjusted life years (DALYs) and years of life saved (YLS), which were used to calculate incremental cost-effectiveness ratios (ICERs) with the WHO 2015 criteria as the base-case scenario. Costs were assessed from a modified social perspective. A budget impact analysis was also done. We tested the robustness of results with a range of sensitiviy analyses including probabilistic sensitivity analysis. Findings: Compared with the WHO criteria, TREAT-B resulted in 4877 DALYs averted and Treat All resulted in 9352 DALYs averted, whereas the EASL criteria led to an excess of 795 DALYs. TREAT-B was cost-saving, whereas the ICER for Treat All (US$2149 per DALY averted) was higher than the cost-effectiveness threshold for The Gambia (0·5 times the country's gross domestic product per capita: $352). These patterns did not change when YLS was the outcome. In a modelled cohort of 5000 adults (aged 20 years) with chronic HBV infection from The Gambia, the 5-year budget impact was $1·14 million for Treat All, $0·66 million for TREAT-B, $1·03 million for the WHO criteria, and $1·16 million for the EASL criteria. Probabilistic sensitivity analysis indicated that among the Treat All, EASL, and TREAT-B algorithms, Treat All would become the most preferred strategy only with a willingness-to-pay threshold exceeding approximately $72 000 per DALY averted or $110 000 per YLS. Interpretation: Although the Treat All strategy might be the most effective, it is unlikely to be cost-effective in The Gambia. A simplified strategy such as TREAT-B might be a cost-saving alternative. Funding: UK Research and Innovation (Medical Research Council). Translation: For the French translation of the abstract see Supplementary Materials section. |
| first_indexed | 2024-03-08T23:37:28Z |
| format | Article |
| id | doaj.art-23b74156053c4367a6668b17bbe2e0e4 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-03-08T23:37:28Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-23b74156053c4367a6668b17bbe2e0e42023-12-14T05:22:48ZengElsevierThe Lancet Global Health2214-109X2024-01-01121e66e78Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysisLiem B Luong Nguyen, PhD0Maud Lemoine, ProfPhD1Gibril Ndow, MD2Zachary J Ward, PhD3Timothy B Hallet, ProfPhD4Umberto D’Alessandro, ProfPhD5Mark Thursz, ProfMD6Shevanthi Nayagam, PhD7Yusuke Shimakawa, PhD8Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France; CIC Cochin Pasteur, Assistance Publique–Hôpitaux de Paris, Paris, FranceDepartment of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK; Medical Research Council Unit, London School of Hygiene & Tropical Medicine, Fajara, The GambiaDepartment of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK; Medical Research Council Unit, London School of Hygiene & Tropical Medicine, Fajara, The GambiaCenter for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USAMedical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UKMedical Research Council Unit, London School of Hygiene & Tropical Medicine, Fajara, The GambiaDepartment of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UKDepartment of Metabolism, Digestion and Reproduction, Division of Digestive Disease, Liver Unit, St Mary's Hospital, Imperial College London, UK; Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UKInstitut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France; Correspondence to: Dr Yusuke Shimakawa, Insitut Pasteur, Université Paris Cité, Unité d’Épidémiologie des Maladies Émergentes, 75015 Paris, FranceSummary: Background: Global elimination of hepatitis B virus (HBV) requires expanded uptake of antiviral therapy, potentially by simplifying testing algorithms, especially in resource-limited countries. We evaluated the effectiveness, cost-effectiveness, and budget impact of three strategies that determine eligibility for anti-HBV treatment, as compared with the WHO 2015 treatment eligibility criteria, in The Gambia. Methods: We developed a microsimulation model of natural history using data from the Prevention of Liver Fibrosis and Cancer in Africa programme (known as PROLIFICA) in The Gambia, for an HBV-infected cohort of individuals aged 20 years. The algorithms included in the model were a conventional strategy using the European Association for the Study of the Liver (EASL) 2017 criteria, a simplified algorithm using hepatitis B e antigen and alanine aminotransferase (the Treatment Eligibility in Africa for the Hepatitis B Virus [TREAT-B] score), a Treat All approach for all HBV-infected individuals, and the WHO 2015 criteria. Outcomes to measure effectiveness were disability-adjusted life years (DALYs) and years of life saved (YLS), which were used to calculate incremental cost-effectiveness ratios (ICERs) with the WHO 2015 criteria as the base-case scenario. Costs were assessed from a modified social perspective. A budget impact analysis was also done. We tested the robustness of results with a range of sensitiviy analyses including probabilistic sensitivity analysis. Findings: Compared with the WHO criteria, TREAT-B resulted in 4877 DALYs averted and Treat All resulted in 9352 DALYs averted, whereas the EASL criteria led to an excess of 795 DALYs. TREAT-B was cost-saving, whereas the ICER for Treat All (US$2149 per DALY averted) was higher than the cost-effectiveness threshold for The Gambia (0·5 times the country's gross domestic product per capita: $352). These patterns did not change when YLS was the outcome. In a modelled cohort of 5000 adults (aged 20 years) with chronic HBV infection from The Gambia, the 5-year budget impact was $1·14 million for Treat All, $0·66 million for TREAT-B, $1·03 million for the WHO criteria, and $1·16 million for the EASL criteria. Probabilistic sensitivity analysis indicated that among the Treat All, EASL, and TREAT-B algorithms, Treat All would become the most preferred strategy only with a willingness-to-pay threshold exceeding approximately $72 000 per DALY averted or $110 000 per YLS. Interpretation: Although the Treat All strategy might be the most effective, it is unlikely to be cost-effective in The Gambia. A simplified strategy such as TREAT-B might be a cost-saving alternative. Funding: UK Research and Innovation (Medical Research Council). Translation: For the French translation of the abstract see Supplementary Materials section.http://www.sciencedirect.com/science/article/pii/S2214109X23004679 |
| spellingShingle | Liem B Luong Nguyen, PhD Maud Lemoine, ProfPhD Gibril Ndow, MD Zachary J Ward, PhD Timothy B Hallet, ProfPhD Umberto D’Alessandro, ProfPhD Mark Thursz, ProfMD Shevanthi Nayagam, PhD Yusuke Shimakawa, PhD Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis The Lancet Global Health |
| title | Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis |
| title_full | Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis |
| title_fullStr | Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis |
| title_full_unstemmed | Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis |
| title_short | Treat All versus targeted strategies to select HBV-infected people for antiviral therapy in The Gambia, west Africa: a cost-effectiveness analysis |
| title_sort | treat all versus targeted strategies to select hbv infected people for antiviral therapy in the gambia west africa a cost effectiveness analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X23004679 |
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