{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:15:27Z","timestamp":1754162127248,"version":"3.41.2"},"reference-count":40,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health Services and Delivery Research Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UNITAID","award":["SPHQ14-LOA -217"],"award-info":[{"award-number":["SPHQ14-LOA -217"]}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI147490"],"award-info":[{"award-number":["R01AI147490"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01AI147490","T32 DA023356"],"award-info":[{"award-number":["R01AI147490","T32 DA023356"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008673","name":"Center for AIDS Research, University of California, San Diego","doi-asserted-by":"publisher","award":["P30 AI036214"],"award-info":[{"award-number":["P30 AI036214"]}],"id":[{"id":"10.13039\/100008673","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2021,1,30]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Over 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, M\u00e9decins Sans Fronti\u00e8res (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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Costs (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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From 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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Using 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2020-004181","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T11:14:54Z","timestamp":1614165294000},"page":"e004181","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0386-2936","authenticated-orcid":false,"given":"Lara K","family":"Marquez","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA"},{"name":"School of Public Health, San Diego State University, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Chaillon","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyi Pyar","family":"Soe","sequence":"additional","affiliation":[{"name":"Medical Department, Dawei Project, Doctors Without Borders, Dawei, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek C","family":"Johnson","sequence":"additional","affiliation":[{"name":"Medical Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Marc","family":"Zosso","sequence":"additional","affiliation":[{"name":"Finance Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Incerti","sequence":"additional","affiliation":[{"name":"Medical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Loarec","sequence":"additional","affiliation":[{"name":"Epidemiology, Epicentre, Paris, \u00cele-de-France, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aude","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Medical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland"},{"name":"Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine G","family":"Walker","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9775-6581","authenticated-orcid":false,"given":"Nyashadzaishe","family":"Mafirakureva","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Lo Re III","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriane","family":"Wynn","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"McIntosh","sequence":"additional","affiliation":[{"name":"School of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan M","family":"Kiene","sequence":"additional","affiliation":[{"name":"School of Public Health, San Diego State University, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Brodine","sequence":"additional","affiliation":[{"name":"School of Public Health, San Diego State University, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard S","family":"Garfein","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Vickerman","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha K","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"2025072913362047000_6.2.e004181.1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32830e6d51"},{"key":"2025072913362047000_6.2.e004181.2","doi-asserted-by":"publisher","DOI":"10.1086\/644771"},{"key":"2025072913362047000_6.2.e004181.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2893.2007.00962.x"},{"key":"2025072913362047000_6.2.e004181.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(15)00485-5"},{"key":"2025072913362047000_6.2.e004181.5","unstructured":"UNAIDS . HIV and AIDS estimates, Myanmar, 2017."},{"key":"2025072913362047000_6.2.e004181.6","unstructured":"Lwin AA AK , Htun MM , Kyaw YY . Sero-Prevalence of hepatitis B and C viral infections in Myanmar: national and regional survey in 2015. Myanmar Health Sciences Research Journal 2017;29."},{"key":"2025072913362047000_6.2.e004181.7","first-page":"68","article-title":"Prevalence and disease burden of HCV coinfection in HIV cohorts in the Asia Pacific region: a systematic review and meta-analysis","volume":"18","author":"Martinello","year":"2016","journal-title":"AIDS Rev"},{"key":"2025072913362047000_6.2.e004181.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-018-3558-y","article-title":"Increased hepatitis C virus co-infection and injection drug use in HIV-infected fishermen in Myanmar","volume":"18","author":"Ousley","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2025072913362047000_6.2.e004181.9","unstructured":"Sciences. G . 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Global health sector strategy on viral hepatitis 2016-2021. Geneva, 2016."},{"key":"2025072913362047000_6.2.e004181.16","unstructured":"Fronti\u00e8res MS . MSF secures generic hepatitis C treatment at $120 compared to $147,000 launch price tag, 2017. Available: https:\/\/msfaccess.org\/msf-secures-generic-hepatitis-c-treatment-120-compared-147000-launch-price-tag [Accessed 21 May 2019]."},{"key":"2025072913362047000_6.2.e004181.17","unstructured":"Fronti\u00e8res MS . 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Life tables Myanmar, 2016."},{"key":"2025072913362047000_6.2.e004181.28","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(15)00069-8"},{"key":"2025072913362047000_6.2.e004181.29","unstructured":"Tan-Torres Edejer T , ed. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis, e.a. Geneva: WHO, 2003."},{"key":"2025072913362047000_6.2.e004181.30","unstructured":"Bank W . GDP per capita, Myanmar, 2018."},{"key":"2025072913362047000_6.2.e004181.31","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27095"},{"key":"2025072913362047000_6.2.e004181.32","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1512610"},{"key":"2025072913362047000_6.2.e004181.33","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1177\/2050640619835394","article-title":"High efficacy of interferon-free therapy for acute hepatitis C in HIV-positive patients","volume":"7","author":"Chromy","year":"2019","journal-title":"United European Gastroenterol J"},{"key":"2025072913362047000_6.2.e004181.34","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s40261-017-0521-4","article-title":"Efficacy of interferon-free therapies for chronic hepatitis C: a systematic review of all randomized clinical trials","volume":"37","author":"Ferreira","year":"2017","journal-title":"Clin Drug Investig"},{"key":"2025072913362047000_6.2.e004181.35","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-2-201301150-00576"},{"key":"2025072913362047000_6.2.e004181.36","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/jvh.12532","article-title":"Direct costs of interferon-based and interferon-free direct-acting antiviral regimens for the treatment of chronic hepatitis C infection","volume":"23","author":"Gray","year":"2016","journal-title":"J Viral Hepat"},{"key":"2025072913362047000_6.2.e004181.37","doi-asserted-by":"crossref","first-page":"595","DOI":"10.2147\/CEOR.S146280","article-title":"The cost of successful antiviral therapy in hepatitis C patients: a comparison of IFN-free versus IFN-based regimens at an individual patient level in Australia","volume":"9","author":"Lee","year":"2017","journal-title":"Clinicoecon Outcomes Res"},{"key":"2025072913362047000_6.2.e004181.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0217964","article-title":"Cost-Effectiveness and budgetary impact of HCV treatment with direct-acting antivirals in India including the risk of reinfection","volume":"14","author":"Chaillon","year":"2019","journal-title":"PLoS One"},{"key":"2025072913362047000_6.2.e004181.39","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-016-0685-x"},{"key":"2025072913362047000_6.2.e004181.40","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/j.jhep.2009.08.001","article-title":"Hcv genotype 3: an independent predictor of fibrosis progression in chronic hepatitis C","volume":"51","author":"De Nicola","year":"2009","journal-title":"J Hepatol"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2020-004181","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T20:36:30Z","timestamp":1753821390000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2020-004181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,24]]},"published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1136\/bmjgh-2020-004181"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2020-004181","relation":{},"ISSN":["2059-7908"],"issn-type":[{"type":"electronic","value":"2059-7908"}],"subject":[],"published":{"date-parts":[[2021,2]]}}}