Cost-utility analysis of four WHO-recommended sofosbuvir-based regimens for the treatment of chronic hepatitis C in sub-Saharan Africa

Boyer, Sylvie; Baudoin, Maël; Nishimwe, Marie Libérée; Santos, Melina; Lemoine, Maud; Maradan, Gwenaëlle; Sylla, Babacar; Kouanfack, Charles; Carrieri, Patrizia; Mourad, Abbas; Rouveau, Nicolas; Moh, Raoul; Seydi, Moussa; Attia, Alain; Woode, Maame Esi; Lacombe, Karine

doi:10.1186/s12913-021-07289-0

Table 1 Model parameters

From: Cost-utility analysis of four WHO-recommended sofosbuvir-based regimens for the treatment of chronic hepatitis C in sub-Saharan Africa

Model parameters	Base-case value	Distribution	95% CI	Source
Cohort characteristics (at model entry)
Age (years)	55	_	_	TAC trial [12]
Proportion of women	45.8	–	–	TAC trial [12]
Fibrosis initial stages^c
F0	0.076	_		[24]
F1	0.392
F2	0.262
F3	0.186
CC	0.084
Effectiveness of the four studied sofosbuvir-based regimens
SVR12 SOF/RBV		–		TAC trial [12]
Non Cirrhotic	0.922		[0.820;0.999] ^b
Cirrhotic	0.793		[0.705;0.859] ^b
SVR12 SOF/LDV		–		TAC trial [12]
Non Cirrhotic	0.909		[0.832;0.973] ^b
Cirrhotic	0.782		[0.716;0.837] ^b
SVR12 SOF/DCV		–		HEPATHER cohort [28]
Non Cirrhotic	0.958		[0.895;1.000] ^b
Cirrhotic	0.824		[0.770;0.870] ^b
SVR12 SOF/VEL		–		HEPATHER cohort [28]
Non Cirrhotic	0.977		[0.913;1.000] ^b
Cirrhotic	0.840		[0.785;0.887] ^b
Natural history of CHC: annual disease transition probabilities between health states in untreated, uncured or re-infected patients
All states → non-CHC related mortality^d	_	_	_	[29]
F0 → F1	0.079	Beta(21.1;234.7)	[0.052;0.119]	[30]
F1 → F2	0.059	Beta(88.4;1399.1)	[0.048;0.072]	[30]
F2 → F3	0.108	Beta(30.0;238.7)	[0.077;0.152]	[30]
F3 → CC	0.077	Beta(14.8;164.1)	[0.047;0.127]	[30]
F3 → DC	0.012	Beta(7.0;558.1)	[0.005;0.023] ^a	[31]
F3 → HCC	0.011	Beta(7.0;558.1)	[0.005;0.023] ^a	[31]
F3 → CHC-related mortality	0.008	Beta(4.9;527.5)	[0.003;0.019] ^a	[31]
CC → DC	0.041	Beta(99.5;2290.4)	[0.034;0.050] ^a	[1]
CC → HCC	0.042	Beta(90.0;2048.7)	[0.034;0.051] ^a	[1]
CC → CHC-related mortality	0.026	Beta(11.5;407.0)	[0.014;0.045] ^a	[31]
DC → HCC	0.068	Beta(37.9;514.7)	[0.049;0.091] ^a	[32]
DC → CHC-related mortality	0.130	Beta(75.7;489.9)	[0.107;0.163] ^a	[32]
HCC → CHC-related mortality	0.900	Beta(186.3;19.9)	[0.86;0.94] ^a	[33]
CHC progression after DAA treatment in cured patients: annual disease transition probabilities between health states
CC → DC	0.023	Beta(14.1;540.5)	[0.014;0.040]^a	[1]
CC → HCC	0.014	Beta(37.9;514.7)	[0.007;0.029]	[1]
CC → CHC-related mortality	0.026	Beta(11.5;407.0)	[0.014;0.045] ^a	[31]
DC → HCC	0.068	Beta(37.9;514.7)	[0.049;0.091] ^a	[32]
DC → CHC-related mortality	0.130	Beta(75.7;489.9)	[0.107;0.163] ^a	[32]
CHC progression after DAA treatment in cured patients: annual disease transition probabilities between health states
HCC → CHC-related mortality	0.900	Beta(186.3;19.9)	[0.86;0.94]	[33]
Annual reinfection probabilities
mono-infected	0.002	Beta(13.2;7051.8)	[0.001;0.003]	[25]
HIV co-infected	0.032	Beta(0.2;13.1)	[0.000;0.123]	[25]
Utilities
In untreated and uncured patients
F0-F3	0.74		[0.718;0.767] ^b	TAC trial [12]
CC	0.71		[0.687;0.732] ^b	TAC trial [12, 34]
DC	0.66		[0.640;0.684] ^b	TAC trial [12, 34]
HCC	0.66		[0.640;0.684] ^b	TAC trial, [12, 35, 36]
During Treatment
F0-F3	0.78		[0.763;0.807] ^b	TAC trial [12]
CC	0.75		[0.729;0.771] ^b	TAC trial [12, 34]
In cured patients
F0-F3	0.81		[0.784;0.826] ^b	TAC trial [12]
CC	0.77		[0.748;0.789] ^b	TAC trial [12, 34]
DC	0.72		[0.698;0.736] ^b	TAC trial [12, 34]
HCC	0.66		[0.640;0.684] ^b	TAC trial [12, 35, 36]
Health states costs
Health states costs with treatment at fibrosis stage				TAC trial [12] and micro-costing study
SOF/RBV
Originator
Cameroon	1660.1	Gamma(5790.7;0.3)	[1617.6;1703.1]
Cote d’Ivoire	1439.7	Gamma(5790.7;0.2)	[1402.9;1477.0]
Senegal	1570.7	Gamma(5790.7;0.3)	[1530.5;1611.4]
Generic
Cameroon	1029.8	Gamma(5790.7;0.2)	[1003.4;1056.5]
Cote d’Ivoire	809.4	Gamma(5790.7;0.1)	[788.7;830.4]
Senegal	940.4	Gamma(5790.7;0.2)	[916.3;964.8]
SOF/LDV
Originator
Cameroon	1692.6	Gamma(5790.7;0.3)	[1649.3;1736.5]
Côte d’Ivoire	1534.2	Gamma(5790.7;0.3)	[1494.9;1574.0]
Senegal	1626.0	Gamma(5790.7;0.3)	[1584.4;1668.1]
Generic
Cameroon	920.4	Gamma(5790.7;0.2)	[896.8;944.3]
Côte d’Ivoire	762.0	Gamma(5790.7;0.1)	[742.5;781.8]
Senegal	853.8	Gamma(5790.7;0.1)	[831.9;875.9]
SOF/DCV
Originator
Cameroon	1577.4	Gamma(5790.7;0.3)	[1537.0;1618.3]
Côte d’Ivoire	1446.5	Gamma(5790.7;0.2)	[1409.5;1484.0]
Senegal	1524.6	Gamma(5790.7;0.3)	[1485.6;1564.1]
Generic
Cameroon	521.4	Gamma(5790.7;0.1)	[508.1;534.9]
Côte d’Ivoire	390.5	Gamma(5790.7;0.1)	[380.5;400.6]
Senegal	468.6	Gamma(5790.7;0.1)	[456.6;480.7]
SOF/VEL
Originator
Cameroon	1226.4	Gamma(5790.7;0.2)	[1195.0;1258.2]
Côte d’Ivoire	1095.5	Gamma(5790.7;0.2)	[1067.5;1123.9]
Senegal	1173.6	Gamma(5790.7;0.2)	[1143.6;1204.0]
Generic
Cameroon	776.4	Gamma(5790.7;0.1)	[756.5;796.5]
Côte d’Ivoire	645.5	Gamma(5790.7;0.1)	[629.0;662.2]
Senegal	723.6	Gamma(5790.7;0.1)	[705.1;742.4]
Health states costs with treatment at CC stage				TAC trial [12] and micro-costing study
SOF/RBV
Originator
Cameroon	1841.3	Gamma(5790.7;0.3)	[1794.2;1889.0]
Côte d’Ivoire	1628.8	Gamma(5790.7;0.3)	[1587.1;1671.0]
Senegal	1790.6	Gamma(5790.7;0.3)	[1744.8;1837.0]
Generic
Cameroon	1211.0	Gamma(5790.7;0.2)	[1180.0;1242.4]
Côte d’Ivoire	998.5	Gamma(5790.7;0.2)	[972.9;1024.4]
Senegal	1160.3	Gamma(5790.7;0.2)	[1130.6;1190.4]
SOF/LDV
Originator
Cameroon	1873.8	Gamma(5790.7;0.3)	[1825.8;1922.4]
Côte d’Ivoire	1723.3	Gamma(5790.7;0.3)	[1679.2;1768.0]
Senegal	1845.9	Gamma(5790.7;0.3)	[1798.7;1893.7]
Generic
Cameroon	1101.6	Gamma(5790.7;0.2)	[1073.4;1130.2]
Côte d’Ivoire	951.1	Gamma(5790.7;0.2)	[926.8;975.8]
Senegal	1073.7	Gamma(5790.7;0.2)	[1046.2;1101.5]
SOF/DCV
Originator
Cameroon	1758.6	Gamma(5790.7;0.3)	[1713.6;1804.2]
Côte d’Ivoire	1635.6	Gamma(5790.7;0.3)	[1593.7;1678.0]
Senegal	1744.5	Gamma(5790.7;0.3)	[1699.9;1789.7]
Generic
Cameroon	702.6	Gamma(5790.7;0.1)	[684.6;720.8]
Côte d’Ivoire	579.6	Gamma(5790.7;0.1)	[564.8;594.6]
Senegal	688.5	Gamma(5790.7;0.1)	[670.9;706.3]
SOF/VEL
Originator
Cameroon	1407.6	Gamma(5790.7;0.2)	[1371.6;1444.1]
Côte d’Ivoire	1284.6	Gamma(5790.7;0.2)	[1251.7;1317.9]
Senegal	1393.5	Gamma(5790.7;0.2)	[1357.8;1429.6]
Generic
Cameroon	957.6	Gamma(5790.7;0.2)	[933.1;982.4]
Côte d’Ivoire	834.6	Gamma(5790.7;0.1)	[813.2;856.2]
Senegal	943.5	Gamma(5790.7;0.2)	[919.4;968.0]
Health states costs without treatment				TAC trial [12] and micro-costing study
F0-F3
Cameroon	0	–	[0.0; 0.0]
Côte d’Ivoire	0	–	[0.0; 0.0]
Senegal	0	–	[0.0; 0.0]
CC
Cameroon	128.7	Gamma(658.5;0.2)	[119.1;138.7]
Côte d’Ivoire	130.9	Gamma(658.5;0.2)	[121.1;141.1]
Senegal	181.5	Gamma(658.5;0.3)	[167.9;195.6]
DC
Cameroon	143.2	Gamma(1380.2;0.1)	[135.7;150.9]
Côte d’Ivoire	144.4	Gamma(1380.2;0.1)	[136.9;152.1]
Senegal	194.0	Gamma(1380.2;0.1)	[183.9;204.4]
HCC
Cameroon	182.6	Gamma(399.6;0.5)	[165.1;200.9]
Côte d’Ivoire	188.4	Gamma(399.6;0.5)	[170.4;207.3]
Senegal	199.3	Gamma(399.6;0.5)	[180.2;219.3]

Abbreviations: CC Compensated Cirrhosis, CHC Chronic Hepatitis C infection, CI Confidence Interval, DC Decompensated Cirrhosis, F0, F1, F2, F3 METAVIR fibrosis stages, SOF/DCV Sofosbuvir/Daclatasvir, SOF/LDV Sofosbuvir/Ledipasvir, SOF/RBV Sofosbuvir/Ribavirin, SOF/VEL Sofosbuvir/Velpatasvir, SVR12 Sustained Virologic Response measured at week 12 after treatment end
^a95% CI calculated using the Wilson score formula.
^b95% CI calculated using the bootstrap technique.
^cThe DSA considered alternative distributions: i) cohorts without CC; ii) cohorts with CC.
^dCountry, sex and age-specific

Back to article page

ISSN: 1472-6963

Contact us

General enquiries: journalsubmissions@springernature.com

BMC Health Services Research

Contact us