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

机译：审美性C缅甸消除：建模影响，成本，成本效益和经济效益

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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, 333,000 new HCV infections and 97,000 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 55,000 people each year was sufficient to reach the national strategy targets and prevented a cumulative 40,000 new infections (12%) and 25,000 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 $553 million by 2030. Reaching the WHO targets required further treatment scale-up and additional direct costs but resulted in greater longer-term benefits. Interpretation: Current levels of HCV testing and treatment in Myanmar are insufficient to reach the national strategy targets. Scaling up HCV testing and treatment in Myanmar to reach the national strategy targets is estimated to generate significant health and economic benefits. Funding: Gilead Sciences.
机译：背景：缅甸已成立全国丙型肝炎病毒（HCV）的目标，以实现人的诊断50％和50％，到2030年，世界卫生组织已经由80％和死亡率降低发病率65％，到2030年的额外的目标处理我们的目的是估算的影响，成本，成本效益，以及实现这些目标的净经济效益。方法：将HCV传播，疾病进展和照顾级联的数学模型进行了校准，以缅甸的15个行政区域。成本数据来自仰光社区检测和治疗程序收集。三种方案被预计2020 - 2030年：（1）基线（检测/治疗的电流电平）;和测试/治疗按比例放大到足以达到（2）的国家战略目标; （3）世界卫生组织目标。调查结果：没有扩大治疗，333000个新的HCV感染和97000 HCV相关的死亡估计发生在缅甸的2020至30年，与HCV成本在直接成本（检测，治疗，疾病管理）共亿$和$ 10.4十亿在生产力损失。在模型中，每年处理55000人足以达到国家战略目标，并防止累计40000个新感染者（12％）至25,000 HCV相关的死亡（25％）2020-2030。这是估计花费在直接成本总计$ 189万美元（每股DALY 243 $避免与没有治疗按比例增加），但只有9.8 $十亿在失去的生产力，使得它的成本节约到2024年从社会的角度来看，估计净经济的5.53亿$的好处在2030年到达世界卫生组织要求的指标进一步扩大治疗和额外的直接成本，但造成了更大的长期利益。解读：在缅甸HCV检测和治疗的目前水平不足以达到国家的战略目标。逐步增加HCV检测和治疗缅甸达成国家战略目标，预计产生显著的健康和经济利益。资金来源：Gilead Sciences公司。

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