Long‐term clinical benefits of Sofosbuvir‐based direct antiviral regimens for patients with chronic hepatitis C in Central and West Africa

Abstract

Background: In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Côte d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct-acting antiviral (DAAs) effectiveness in West and Central Africa. Methods: Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n = 3224), Côte d'Ivoire (n = 9748) and Senegal (n = 6358). Lifetime treatment benefits were assessed using (a) life-years saved (LYS); (b) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma; and (c) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty.

Feasability and effectiveness of scaling up hepatitis-C treatment in West and Central Africa: the TAC ANRS 12311 clinical trial

“…First, effective access to treatment and laboratory monitoring remains a major barrier as the costs of the drugs-even generics-and biological tests are still not affordable for the majority of populations affected by chronic HCV infection. Next, expanding HCV testing and access to DAAs to reach HCV elimination is challenging because the increase in expenditures to ensure effective case nding and HCV cure is too onerous to governments or potentially so to individuals and families [32,33]. Concerning access to DAA, agreements with the two DAA drug license owners (Gilead for sofosbuvir, ledipasvir and velpatasvir, and Bristol-Myers Squibb for daclatasvir) allow for the production and sale of generic DAAs in 100 LMICs [34,35].…”