Hepatitis C elimination in Myanmar: Modelling the impact, cost, cost-effectiveness and economic benefits

Abstract

Background: Myanmar has set national hepatitis C (HCV) targets to achieve 50% of people diagnosed and 50% treated by 2030. The WHO has additional targets of reducing incidence by 80% and mortality by 65% by 2030. We aimed to estimate the impact, cost, cost-effectiveness and net economic benefit of achieving these targets. Methods: Mathematical models of HCV transmission, disease progression and the care cascade were calibrated to 15 administrative regions of Myanmar. Cost data were collected from a community testing and treatment program in Yangon. Three scenarios were projected for 2020-2030: (1) baseline (current levels of testing/treatment); and testing/treatment scaled up sufficiently to reach (2) the national strategy targets; and (3) the WHO targets. Findings: Without treatment scale-up, 333,0 0 0 new HCV infections and 97,0 0 0 HCV-related deaths were estimated to occur in Myanmar 2020-2030, with HCV costing a total $100 million in direct costs (testing, treatment, disease management) and $10.4 billion in lost productivity. In the model, treating 55,0 0 0 people each year was sufficient to reach the national strategy targets and prevented a cumulative 40,0 0 0 new infections (12%) and 25,0 0 0 HCV-related deaths (25%) 2020-2030. This was estimated to cost a total $189 million in direct costs ($243 per DALY averted compared to no treatment scale-up), but only $9.8 billion in lost productivity, making it cost-saving from a societal perspective by 2024 with an estimated net economic benefit of $553 million by 2030. Reaching the WHO targets required further treatment scale-up and additional direct costs but resulted in greater longer-term benefits. Interpretation: Current levels of HCV testing and treatment in Myanmar are insufficient to reach the national strategy targets. Scaling up HCV testing and treatment in Myanmar to reach the national strategy targets is estimated to generate significant health and economic benefits. Funding: Gilead Sciences.

Cancer Incidence and Mortality in Central Myanmar: Report of Nay Pyi Taw Population-Based Cancer Registry

“…Under the Expanded Program of Immunization (EPI), coverage of nationwide immunization for HBV at birth was 14% and childhood was 91% in 2019 (Sandhu et al, 2020). Myanmar's hepatitis control program is providing freeof-charge viral hepatitis C treatment at 12 public hospitals in 8 different states and regions starting in 2017 (Scott et al, 2021). Therefore, primary prevention through Human Papilloma Virus (HPV) vaccination and expanding the availability of HPV and HCV treatments in the country would lead to prevent people from liver cancers as well as significant reduction in liver cancers related deaths in the future.…”

Evaluation of Simplified HCV Diagnostics in HIV/HCV Co-Infected Patients in Myanmar

“…DAA therapy has improved HCV management in low- and middle-income countries (LMIC), which have the highest global HCV burden [ 2 ]. Although Myanmar has set national targets to diagnose and treat 50% of people living with HCV by 2030, the current HCV testing and treatment levels are inadequate [ 3 ]. The cost of diagnostics and DAA therapy [ 4 ], and the accessibility to testing and treatment remain barriers to HCV treatment in Myanmar [ 5 ], similar to other LMIC [ 6 , 7 ].…”

“…In people living with Human Immunodeficiency Virus, estimates of HCV co-infection range from 5% to 23% [ 5 , 9 ]. Without a treatment scale-up, it is estimated that 333,000 new HCV infections and 97,000 HCV-related deaths will occur in Myanmar between 2020 and 2030 [ 3 ]. Standard of care HCV RNA testing is available throughout Myanmar as part of the National Hepatitis Control program that was launched in 2017, and the national HCV treatment guidelines—issued in the same year—provide a comprehensive treatment pathway: antibody screening by immunoassay, a confirmation by viral load testing, a series of pre-treatment assessments ( HIV testing, liver staging and renal function) and a confirmation of SVR 12 weeks post-treatment [ 10 ].…”

Feasibility of decentralised, task-shifted hepatitis C testing and treatment services in urban Myanmar: implications for scale-up

“…The national treatment programme has treated approximately 11 000 people living with HCV, 17 but considerable scale-up and expansion is required to reach all affected. 18 Fortunately, general practitioners (GPs) can prescribe DAAs and national guidelines also support simplified pretreatment assessments (no genotyping or FibroScan). 19 Creating and evaluating a simplified clinical pathway and model of care for Myanmar is an important step towards expanding decentralised primary care-based HCV testing and treatment.…”

“…Access to HCV care is limited by the number of hepatologists (estimated at 25 nationwide) and unaffordability of diagnostics and DAAs. The national treatment programme has treated approximately 11 000 people living with HCV,17 but considerable scale-up and expansion is required to reach all affected 18. Fortunately, general practitioners (GPs) can prescribe DAAs and national guidelines also support simplified pretreatment assessments (no genotyping or FibroScan) 19.…”