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@article{Heffernan:2021:10.1371/journal.pone.0245288,
author = {Heffernan, A and Ma, Y and Nayagam, S and Chan, P and Chen, Z and Cooke, GS and Guo, Y and Liu, C and Thursz, M and Zhang, W and Zhang, X and Zhang, X and Jia, M and Hallett, TB},
doi = {10.1371/journal.pone.0245288},
journal = {PLoS One},
pages = {1--17},
title = {Economic and epidemiological evaluation of interventions to reduce the burden of hepatitis C in Yunnan province, China},
url = {http://dx.doi.org/10.1371/journal.pone.0245288},
volume = {16},
year = {2021}
}

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TY  - JOUR
AB  - BackgroundThe paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China.Methods and findingsWe simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17–1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream
AU  - Heffernan,A
AU  - Ma,Y
AU  - Nayagam,S
AU  - Chan,P
AU  - Chen,Z
AU  - Cooke,GS
AU  - Guo,Y
AU  - Liu,C
AU  - Thursz,M
AU  - Zhang,W
AU  - Zhang,X
AU  - Zhang,X
AU  - Jia,M
AU  - Hallett,TB
DO  - 10.1371/journal.pone.0245288
EP  - 17
PY  - 2021///
SN  - 1932-6203
SP  - 1
TI  - Economic and epidemiological evaluation of interventions to reduce the burden of hepatitis C in Yunnan province, China
T2  - PLoS One
UR  - http://dx.doi.org/10.1371/journal.pone.0245288
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000609985300006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245288
UR  - http://hdl.handle.net/10044/1/87020
VL  - 16
ER  -

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