title: How to optimize hepatitis C virus treatment impact on life years saved in resource-constrained countries.
abstract: In resource-constrained countries where the prevalence of hepatitis C virus (HCV) disease is usually high, it is important to know which population should be treated first in order to increase treatment effectiveness. The aim was to estimate the effectiveness of different HCV treatment eligibility scenarios in three different countries. Using a Markov model, we estimated the number of life-years saved (LYS) with different treatment eligibility scenarios according to fibrosis stage (F1-F4 or F3-4), compared to base case (F2-F4), at a constant treatment rate, of patients between 18 and 60 years of age, at stages F0/F1 to F4, without liver complications or coinfections, chronically infected by HCV, and treated with pegylated interferon (IFN)/ribavirin or more-efficacious therapies (i.e. IFN free). We conducted the analysis in Egypt (prevalence = 14.7%; 45,000 patients treated/year), Thailand (prevalence = 2.2%; 1,000 patients treated/year), and Côte d'Ivoire (prevalence = 3%; 150 patients treated/year). In Egypt, treating F1 patients in addition to ≥F2 patients (SE1 vs. SE0) decreased LYS by 3.9%. Focusing treatment only on F3-F4 patients increased LYS by 6.7% (SE2 vs. SE0). In Thailand and Côte d'Ivoire, focusing treatment only on F3-F4 patients increased LYS by 15.3% and 11.0%, respectively, compared to treating patients ≥F2 (ST0 and SC0, respectively). Treatment only for patients at stages F3-F4 with IFN-free therapies would increase LYS by 16.7% versus SE0 in Egypt, 22.0% versus ST0 in Thailand, and 13.1% versus SC0 in Côte d'Ivoire. In this study, we did not take into account the yearly new infections and the impact of treatment on HCV transmission.
  
  
  CONCLUSIONS
  Our model-based analysis demonstrates that prioritizing treatment in F3-F4 patients in resource-constrained countries is the most effective scenario in terms of LYS, regardless of treatment considered.
authors.affiliation: Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Obach
authors.affiliation: Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: Esmat
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand.|Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Sahar
authors.initials: S
authors.lastname: Dewedar
authors.affiliation: TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.affiliation: UFR des Sciences Médicales, Université Félix Houphouet Boigny de Cocody, Abidjan, Côte d'Ivoire.|Service de Médecine et d'Hépato-Gastroentérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: Alain
authors.initials: A
authors.lastname: Attia
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Wagida A
authors.initials: WA
authors.lastname: Anwar
authors.affiliation: Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Cousien
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Pisit
authors.initials: P
authors.lastname: Tangkijvanich
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.|Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Abidjan, Côte d'Ivoire.|Programme PAC-CI, ANRS, Abidjan, Côte d'Ivoire.
authors.forename: Serge Paul
authors.initials: SP
authors.lastname: Eholié
authors.affiliation: National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
authors.forename: Wahid
authors.initials: W
authors.lastname: Doss
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Aya
authors.initials: A
authors.lastname: Mostafa
authors.affiliation: Institut Pasteur, Emerging Disease Epidemiology Unit, Paris, France.|Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mostafa K
authors.initials: MK
authors.lastname: Mohamed
authors.affiliation: Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm U995, Université Lille Nord de France, Lille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deuffic-Burban
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008962:Models, Theoretical
chemical_list: D000998:Antiviral Agents