{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T18:36:34Z","timestamp":1785090994385,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,6,21]],"date-time":"2020-06-21T00:00:00Z","timestamp":1592697600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004409","name":"Doctors Without Borders","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004409","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000883","name":"University of Bristol","doi-asserted-by":"publisher","award":["IS\u2010HPU\u20101112\u201010026"],"award-info":[{"award-number":["IS\u2010HPU\u20101112\u201010026"]}],"id":[{"id":"10.13039\/501100000883","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>In 2016, M\u00e9decins Sans Fronti\u00e8res established the first general population Hepatitis C virus (HCV) screening and treatment site in Cambodia, offering free direct\u2010acting antiviral (DAA) treatment. This study analysed the cost\u2010effectiveness of this intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Costs, quality adjusted life years (QALYs) and cost\u2010effectiveness of the intervention were projected with a Markov model over a lifetime horizon, discounted at 3%\/year. Patient\u2010level resource\u2010use and outcome data, treatment costs, costs of HCV\u2010related healthcare and EQ\u20105D\u20105L health states were collected from an observational cohort study evaluating the effectiveness of DAA treatment under full and simplified models of care compared to no treatment; other model parameters were derived from literature. Incremental cost\u2010effectiveness ratios (cost\/QALY gained) were compared to an opportunity cost\u2010based willingness\u2010to\u2010pay threshold for Cambodia ($248\/QALY).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The total cost of testing and treatment per patient for the full model of care was $925(IQR $668\u20101631), reducing to $376(IQR $344\u2010422) for the simplified model of care. EQ\u20105D\u20105L values varied by fibrosis stage: decompensated cirrhosis had the lowest value, values increased during and following treatment. The simplified model of care was cost saving compared to no treatment, while the full model of care, although cost\u2010effective compared to no treatment ($187\/QALY), cost an additional $14\u00a0485\/QALY compared to the simplified model, above the willingness\u2010to\u2010pay threshold for Cambodia. This result is robust to variation in parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The simplified model of care was cost saving compared to no treatment, emphasizing the importance of simplifying pathways of care for improving access to HCV treatment in low\u2010resource settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14550","type":"journal-article","created":{"date-parts":[[2020,5,31]],"date-time":"2020-05-31T19:00:15Z","timestamp":1590951615000},"page":"2356-2366","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Cost and cost\u2010effectiveness of a simplified treatment model with direct\u2010acting antivirals for chronic hepatitis C in Cambodia"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9732-5738","authenticated-orcid":false,"given":"Josephine G.","family":"Walker","sequence":"first","affiliation":[{"name":"Population Health Sciences Bristol Medical School University of Bristol Bristol England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyashadzaishe","family":"Mafirakureva","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol Medical School University of Bristol Bristol England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momoko","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"},{"name":"M\u00e9decins Sans Fronti\u00e8res \u2013 France Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Campbell","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol Medical School University of Bristol Bristol England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chamroeun San","family":"Kim","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res \u2013 France Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben A.","family":"Hastings","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol Medical School University of Bristol Bristol England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Philippe","family":"Doussett","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res \u2013 France Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mickael","family":"Le Paih","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res \u2013 France Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suna","family":"Balkan","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res \u2013 France Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonia","family":"Marquardt","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res \u2013 France Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Maman","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Loarec","sequence":"additional","affiliation":[{"name":"Epicentre Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Coast","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol Medical School University of Bristol Bristol England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vickerman","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol Medical School University of Bristol Bristol England"},{"name":"National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions University of Bristol Bristol England"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,21]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"World Health Organization.Global hepatitis report 2017;2017.http:\/\/apps.who.int\/iris\/bitstream\/10665\/255016\/1\/9789241565455\u2010eng.pdf?ua=1. 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