CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

physicians or nurses). Data were pooled using random effects meta-analysis and meta-regression was used to explore heterogeneity. Results: 97 studies from 18 countries (11 were LMIC) were included. 82 were single arm studies and 15 had a comparator arm (RCTs, non-RCT or cohort studies). 40 (41.2%) were in PWID, 13 (13.4%) in prisoners, 42 (43.3%) in general population, and 2 in PLHIV. 34 and 35 studies respectively used DAA and IFN based regimens. Among PWID, FD (n=29) compared to PD (n=11) had higher testing uptake 88% (95%CI 78-98) vs. 47% (95%CI 4-99), and linkage to care 80% (95%CI 62-98) vs. 53% (95%CI 30-77), but similar SVR rates: FD 93% (95%CI 89-97) vs PD 88% (95% CI 84–93). Results were similar for FD (n=19) and PD (n=23) in general population studies. Task-shifting to non-specialists achieved similar SVR12 to specialist care for both PWID 92% (95%CI 88-97) vs. 92% (95%CI 85-99) and in general population 92% (95%CI 87–96) vs. 91% (95%CI 87–95). Conclusion: Both decentralization and task-shifting to non-specialists achieved high levels of HCV cure across a range of populations and settings. These findings support adoption of these service delivery models to promote testing and treatment scale-up in national programmes. 589 THE COST-EFFECTIVENESS OF HCV SCREENING OF PREGNANT WOMEN IN THE UNITED STATES Antoine Chaillon 1 , Nancy S. Reau 2 , Elizabeth B. Rand 3 , Natasha Martin 1 1 University of California San Diego, La Jolla, CA, USA, 2 Rush University, Chicago, IL, USA, 3 University of Pennsylvania, Philadelphia, PA, USA Background: Hepatitis C Virus (HCV) chronic prevalence among pregnant women in the United States (U.S.) is estimated at 0.7%, but can reach 8% in rural Tennessee, and doubled nationally from 2009-2014. Yet, screening for pregnant women is not currently recommended by the U.S. Centers for Disease Control, and many pregnant women remain undiagnosed. Recent AASLD/IDSA guidelines and the state of Kentucky recommend screening pregnant women but note low quality and strength of evidence supporting this recommendation. We assess the cost-effectiveness of HCV screening for pregnant women in the U.S. Methods: A deterministic HCV natural history Markov model among pregnant women was used to evaluate the cost-effectiveness of HCV screening of pregnant women compared to no screening from a health care payer perspective. We assumed 0.73% (95%CI 0.71-0.75) HCV chronic prevalence among pregnant women based on national data. Given differing state-based Medicaid reimbursement policies, we explored the cost-effectiveness of antenatal screening in settings with differing treatment eligibility: METAVIR stage F3 or beyond (F3+), F2 or beyond (F2+), or F0 and beyond (F0+). We assessed cost (in US $) and health outcomes (in quality-adjusted life years, QALYs) over a lifetime horizon. We sampled 1000 parameter sets and calculated mean incremental cost-effectiveness ratios (ICERs), assessing cost-effectiveness under a willingness to pay threshold of $50,000/QALY gained. Using state- specific pregnancy rates and fibrosis restrictions, we estimate the impact of screening. Results: The mean ICERs for antenatal screening were $6303, $8594 and $13677 per QALY gained in the F3+, F2+, and F0+, treatment eligibility scenarios, respectively compared to no screening. Screening was cost-effective under a $50,000 willingness-to-pay threshold in all simulations. Screening remained cost-effective for prevalences at or above 0.05-0.08% depending on treatment eligibility (Fig. 1). In a state with 8% prevalence and F2+ restrictions like Tennessee, the ICER was $5,288. Screening the estimated 5.04 million pregnant women in 2018 could result in detection and treatment of 33,000 women in the United States based on current fibrosis restrictions. Conclusion: Screening pregnant women for HCV in the U.S. is likely cost effective assuming a national prevalence of 0.7%, and should be recommended. In geographical areas with higher prevalence, such as Appalachia, cost- effectiveness is even greater.

Poster Abstracts

590 COST-EFFECTIVENESS OF HCV TREATMENT AMONG HIV-POSITIVE INDIVIDUALS IN MYANMAR Lara K. Marquez 1 , Antoine Chaillon 1 , Kyi Pyar Soe 2 , Derek Johnson 3 , Jean-Marc Zosso 2 , Andrea Incerti 3 , Anne Loarec 4 , Aude Nguyen 5 , Josephine Walker 6 , Nyashadzaishe Mafirakureva 6 , Peter Vickerman 6 , Natasha Martin 1 1 University of California San Diego, San Diego, CA, USA, 2 Medecins sans Frontieres, Dawei, Myanmar, 3 Medecins sans Frontieres, Yangon, Myanmar, 4 Medecins sans Frontieres, Paris, France, 5 Geneva University Hospitals, Genève, Switzerland, 6 University of Bristol, Bristol, UK Background: Over half of those co-infected with hepatitis C virus (HCV) and HIV live in low- and middle-income countries, and new HCV direct-acting antiviral therapies (DAAs) cure >90% of individuals. However, the cost- effectiveness of DAAs among HIV/HCV coinfected individuals in low-income settings is unclear. In 2016, Médecins sans Frontières (MSF) began HCV treatment within a HIV cohort in Myanmar. We evaluated the cost-effectiveness of the HCV treatment program among HIV/HCV coinfected patients in Myanmar. Methods: We assessed the real-world cost and cost-effectiveness of HCV DAA treatment among HIV-positive individuals compared to no treatment from a program provider’s perspective. Patient characteristics, costs and treatment outcomes were collected from an ongoing, prospective cohort study in Dawei, Myanmar. We performed a patient-level micro-costing analysis of DAA treatment delivery. A Markov model of HCV disease progression among HIV-infected individuals was developed and used to estimate lifetime costs (in 2017 $USD) and health outcomes (in disability-adjusted life-years (DALYs)), discounted at 3% per year. Disease state transitions and disability weights were informed from published literature. We calculate the incremental cost- effectiveness ratio (ICER, difference in costs divided by difference in DALYs), compared to a willingness to pay threshold of the per capita GDP in Myanmar ($1275). We additionally evaluate the potential cost-effectiveness utilizing a simplified treatment protocol with about 25% fewer visits and task-shifting from doctors to nurses. Results: From November 2016 to October 2017, 122 patients initiated treatment (66 METAVIR stage F0-F3, 56 cirrhosis or later), 96% (n=117) achieved SVR. Under the current treatment protocol, the average cost of treatment per patient was $677 and $1302 for patients in F0-F3 and cirrhosis or later, respectively, mainly due to drug costs ($493 and $939 for 12 and 24 weeks, respectively for sofosbuvir/daclatasavir). The current treatment protocol costs an incremental $938.79 per patient treated, resulting in 1.33 DALYs averted per patient, resulting in an ICER of $707/DALY averted compared to no treatment. A simplified treatment protocol could result in an ICER of $424/DALY averted compared to no treatment.

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