Yueran Zhuo, PhD
Assistant Professor of Quantitative Analysis, Mississippi State Univ. College of Business
Dr. Zhuo is an Assistant Professor of Quantitative Analysis at the Mississippi State University College of Business. She was a post-doctoral research fellow working with Dr. Jagpreet Chhatwal. She joined MGH-ITA as a clinical research coordinator in January 2018. She earned her PhD in Management Science at the University of Massachusetts Amherst in 2019. She received a BS degree in Chemistry in 2010 and MEng degree in Control Engineering in 2012, both at Nankai University, China.
Yueran’s research interest lies in operations management, with applications in health care. Her main methodology involves optimization with uncertainties, including stochastic programming, dynamic modeling, and simulation. She is currently working in the area of Hepatitis C virus infection, with a focus on the cost-effectiveness analysis and health economics of the disease screening and treatment.
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Selected Publications
Zhong, Huaiyang; Aaron, Alec; Hiebert, Lindsey; Serumondo, Janvier; Zhuo, Yueran; Adee, Madeline; Rwibasira, Gallican N; Ward, John W; Chhatwal, Jagpreet
Hepatitis C Elimination in Rwanda: Progress, Feasibility, and Economic Evaluation Journal Article
In: Value Health, 2024, ISSN: 1524-4733.
@article{pmid38492923,
title = {Hepatitis C Elimination in Rwanda: Progress, Feasibility, and Economic Evaluation},
author = {Huaiyang Zhong and Alec Aaron and Lindsey Hiebert and Janvier Serumondo and Yueran Zhuo and Madeline Adee and Gallican N Rwibasira and John W Ward and Jagpreet Chhatwal},
doi = {10.1016/j.jval.2024.03.005},
issn = {1524-4733},
year = {2024},
date = {2024-03-01},
journal = {Value Health},
abstract = {OBJECTIVE: In 2018, Rwanda launched a national program to eliminate the hepatitis C virus (HCV). We aim to assess the impact of the program to date and identify strategies to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: We developed a microsimulation model to simulate Rwanda's HCV epidemic from 2015 through 2050 and evaluated temporal trends in HCV infection, prevalence, mortality, and the total cost of care for scenarios that could achieve HCV elimination by 2030.nnRESULTS: Between 2018 and 2022, over 7 million people were screened for HCV, and 60,000 were treated. The study projected that Rwanda could achieve HCV elimination as early as 2027. A feasible strategy of an annual screening rate of 15% and a treatment rate of 100% would achieve all WHO elimination goals by 2028, requiring screening an additional 4 million people and treating 23,900 patients by 2030. The elimination strategy costs $25 million for screening and diagnosis and $21 million for treatment from 2015 to 2050. The national program would avert 4,900 hepatocellular carcinoma cases and 6,700 HCV-related deaths and save the health system $25.33 million from 2015 to 2050.nnCONCLUSIONS: Rwanda is poised to become one of the first countries in the world to eliminate HCV. Rwanda's program serves as a blueprint for other countries in the African region. By rapid screening and treatment scale-up (e.g., by leveraging HIV platforms) and by drug price negotiations, HCV elimination is not only feasible but can be cost-saving in low-income settings.},
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OBJECTIVE: In 2018, Rwanda launched a national program to eliminate the hepatitis C virus (HCV). We aim to assess the impact of the program to date and identify strategies to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: We developed a microsimulation model to simulate Rwanda's HCV epidemic from 2015 through 2050 and evaluated temporal trends in HCV infection, prevalence, mortality, and the total cost of care for scenarios that could achieve HCV elimination by 2030.nnRESULTS: Between 2018 and 2022, over 7 million people were screened for HCV, and 60,000 were treated. The study projected that Rwanda could achieve HCV elimination as early as 2027. A feasible strategy of an annual screening rate of 15% and a treatment rate of 100% would achieve all WHO elimination goals by 2028, requiring screening an additional 4 million people and treating 23,900 patients by 2030. The elimination strategy costs $25 million for screening and diagnosis and $21 million for treatment from 2015 to 2050. The national program would avert 4,900 hepatocellular carcinoma cases and 6,700 HCV-related deaths and save the health system $25.33 million from 2015 to 2050.nnCONCLUSIONS: Rwanda is poised to become one of the first countries in the world to eliminate HCV. Rwanda's program serves as a blueprint for other countries in the African region. By rapid screening and treatment scale-up (e.g., by leveraging HIV platforms) and by drug price negotiations, HCV elimination is not only feasible but can be cost-saving in low-income settings.
Aaron, Alec; Zhong, Huaiyang; Hiebert, Lindsey; Zhuo, Yueran; Adee, Madeline; Paraschiv, Angela; Stratulat, Silvia; Ward, John W; Chhatwal, Jagpreet
Hepatitis C Elimination in Moldova Is Feasible and Cost-Saving: A Modeling Study Journal Article
In: J Infect Dis, vol. 228, no. Supplement_3, pp. S189–S197, 2023, ISSN: 1537-6613.
@article{pmid37703345,
title = {Hepatitis C Elimination in Moldova Is Feasible and Cost-Saving: A Modeling Study},
author = {Alec Aaron and Huaiyang Zhong and Lindsey Hiebert and Yueran Zhuo and Madeline Adee and Angela Paraschiv and Silvia Stratulat and John W Ward and Jagpreet Chhatwal},
doi = {10.1093/infdis/jiad138},
issn = {1537-6613},
year = {2023},
date = {2023-09-13},
urldate = {2023-09-01},
journal = {J Infect Dis},
volume = {228},
number = {Supplement_3},
pages = {S189--S197},
abstract = {BACKGROUND: Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: This study adapted a previously developed microsimulation model to simulate the HCV epidemic in Moldova from 2004 to 2050. Model outcomes included temporal trends in HCV infection, prevalence, mortality, and total cost of care, including screening and treatment. We evaluated scenarios that could eliminate HCV by 2030.nnRESULTS: Multiple strategies could lead to HCV elimination in Moldova by 2030. A realistic scenario of a 20% annual screening and 80% treatment rate would require 2.75 million individuals to be screened and 65 000 treated by 2030. Compared to 2015, this program will reduce HCV incidence by 98% and HCV-related deaths by 72% in 2030. Between 2022 and 2030, this strategy would cost $17.5 million for HCV screening and treatment. However, by 2050, the health system would save \>$85 million compared to no investment in elimination efforts.nnCONCLUSIONS: HCV elimination in Moldova is feasible and can be cost saving, but requires resources to scale HCV screening and treatment.},
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BACKGROUND: Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: This study adapted a previously developed microsimulation model to simulate the HCV epidemic in Moldova from 2004 to 2050. Model outcomes included temporal trends in HCV infection, prevalence, mortality, and total cost of care, including screening and treatment. We evaluated scenarios that could eliminate HCV by 2030.nnRESULTS: Multiple strategies could lead to HCV elimination in Moldova by 2030. A realistic scenario of a 20% annual screening and 80% treatment rate would require 2.75 million individuals to be screened and 65 000 treated by 2030. Compared to 2015, this program will reduce HCV incidence by 98% and HCV-related deaths by 72% in 2030. Between 2022 and 2030, this strategy would cost $17.5 million for HCV screening and treatment. However, by 2050, the health system would save >$85 million compared to no investment in elimination efforts.nnCONCLUSIONS: HCV elimination in Moldova is feasible and can be cost saving, but requires resources to scale HCV screening and treatment.
Adee, Madeline; Zhong, Huaiyang; Reipold, Elena Ivanova; Zhuo, Yueran; Shilton, Sonjelle; Chhatwal, Jagpreet
Cost-Effectiveness of a Core Antigen-Based Rapid Diagnostic Test for Hepatitis C Journal Article
In: Value Health, 2022, ISSN: 1524-4733.
@article{pmid35272954,
title = {Cost-Effectiveness of a Core Antigen-Based Rapid Diagnostic Test for Hepatitis C},
author = {Madeline Adee and Huaiyang Zhong and Elena Ivanova Reipold and Yueran Zhuo and Sonjelle Shilton and Jagpreet Chhatwal},
doi = {10.1016/j.jval.2022.01.004},
issn = {1524-4733},
year = {2022},
date = {2022-03-01},
journal = {Value Health},
abstract = {OBJECTIVES: Hepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use-particularly in low- and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources.
METHODS: We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon.
RESULTS: Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia.
CONCLUSIONS: We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Hepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use-particularly in low- and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources.
METHODS: We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon.
RESULTS: Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia.
CONCLUSIONS: We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.
METHODS: We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon.
RESULTS: Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia.
CONCLUSIONS: We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.
Adee, Madeline; Zhuo, Yueran; Zhong, Huaiyang; Zhan, Tiannan; Aggarwal, Rakesh; Shilton, Sonjelle; Chhatwal, Jagpreet
Author Correction: Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator. Journal Article
In: Scientific reports, vol. 12, iss. 1, pp. 3101, 2022, ISSN: 2045-2322.
@article{Adee2022,
title = {Author Correction: Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator.},
author = {Madeline Adee and Yueran Zhuo and Huaiyang Zhong and Tiannan Zhan and Rakesh Aggarwal and Sonjelle Shilton and Jagpreet Chhatwal},
url = {https://pubmed.ncbi.nlm.nih.gov/35177757/},
doi = {10.1038/s41598-022-07001-0},
issn = {2045-2322},
year = {2022},
date = {2022-02-01},
journal = {Scientific reports},
volume = {12},
issue = {1},
pages = {3101},
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tppubtype = {article}
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Adee, Madeline; Zhuo, Yueran; Zhong, Huaiyang; Zhan, Tiannan; Aggarwal, Rakesh; Shilton, Sonjelle; Chhatwal, Jagpreet
Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator. Journal Article
In: Scientific reports, vol. 11, pp. 21382, 2021, ISSN: 2045-2322, ().
@article{Adee2021a,
title = {Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator.},
author = {Madeline Adee and Yueran Zhuo and Huaiyang Zhong and Tiannan Zhan and Rakesh Aggarwal and Sonjelle Shilton and Jagpreet Chhatwal},
url = {https://pubmed.ncbi.nlm.nih.gov/34725356/},
doi = {10.1038/s41598-021-00362-y},
issn = {2045-2322},
year = {2021},
date = {2021-11-01},
journal = {Scientific reports},
volume = {11},
pages = {21382},
abstract = {The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (123 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.},
keywords = {},
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The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (123 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.
Adee, Madeline; Zhuo, Yueran; Zhan, Tiannan; Chen, Qiushi; Toumi, Asmae; Ayer, Turgay; Nwankwo, Chizoba; Zhong, Huaiyang; Puenpatom, Amy; Chhatwal, Jagpreet
A Tool to Inform Hepatitis C Elimination: A Case for Hepatitis C Elimination in China. Journal Article
In: Clinical liver disease, vol. 17, pp. 99–106, 2021, ISSN: 2046-2484, ().
@article{Adee2021,
title = {A Tool to Inform Hepatitis C Elimination: A Case for Hepatitis C Elimination in China.},
author = {Madeline Adee and Yueran Zhuo and Tiannan Zhan and Qiushi Chen and Asmae Toumi and Turgay Ayer and Chizoba Nwankwo and Huaiyang Zhong and Amy Puenpatom and Jagpreet Chhatwal},
url = {https://pubmed.ncbi.nlm.nih.gov/33868647/},
doi = {10.1002/cld.1109},
issn = {2046-2484},
year = {2021},
date = {2021-03-01},
urldate = {2021-03-01},
journal = {Clinical liver disease},
volume = {17},
pages = {99--106},
keywords = {},
pubstate = {published},
tppubtype = {article}
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Zhuo, Yueran; Hayashi, Tomoyuki; Chen, Qiushi; Aggarwal, Rakesh; Hutin, Yvan; Chhatwal, Jagpreet
Estimating the price at which hepatitis C treatment with direct-acting antivirals would be cost-saving in Japan. Journal Article
In: Scientific reports, vol. 10, no. 1, pp. 4089, 2020, ISSN: 2045-2322, ().
@article{Zhuo2020,
title = {Estimating the price at which hepatitis C treatment with direct-acting antivirals would be cost-saving in Japan.},
author = {Yueran Zhuo and Tomoyuki Hayashi and Qiushi Chen and Rakesh Aggarwal and Yvan Hutin and Jagpreet Chhatwal},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32139872},
doi = {10.1038/s41598-020-60986-4},
issn = {2045-2322},
year = {2020},
date = {2020-03-01},
urldate = {2020-03-01},
journal = {Scientific reports},
volume = {10},
number = {1},
pages = {4089},
abstract = {In Japan, 1.5-2 million people are chronically infected with hepatitis C virus (HCV) infection. New direct-acting antiviral agents (DAA) offer an unprecedented opportunity to cure HCV. While the price of HCV treatment decreased recently in most countries, it remains one of the highest in Japan. Our objective was to evaluate the cost-effectiveness of HCV treatment in patients of different age groups and to estimate the price at which DAAs become cost-saving in Japan. A previously developed microsimulation model was adapted to the Japanese population and updated with Japan-specific health utilities and costs. Our model showed that compared with no treatment, the incremental cost-effectiveness ratio (ICER) of DAAs at a price USD 41,046 per treatment was USD 9,080 per quality-adjusted life year (QALY) gained in 60-year-old patients. HCV treatment became cost-effective after 9 years of starting treatment. However, if the price of DAAs is reduced by 55-85% (USD 6,730 to 17,720), HCV treatment would be cost-saving within a 5 to 20-year time horizon, which should serve to increase the uptake of DAA-based HCV treatment. The payers of health care in Japan could examine ways to procure DAAs at a price where they would be cost-saving.},
keywords = {},
pubstate = {published},
tppubtype = {article}
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In Japan, 1.5-2 million people are chronically infected with hepatitis C virus (HCV) infection. New direct-acting antiviral agents (DAA) offer an unprecedented opportunity to cure HCV. While the price of HCV treatment decreased recently in most countries, it remains one of the highest in Japan. Our objective was to evaluate the cost-effectiveness of HCV treatment in patients of different age groups and to estimate the price at which DAAs become cost-saving in Japan. A previously developed microsimulation model was adapted to the Japanese population and updated with Japan-specific health utilities and costs. Our model showed that compared with no treatment, the incremental cost-effectiveness ratio (ICER) of DAAs at a price USD 41,046 per treatment was USD 9,080 per quality-adjusted life year (QALY) gained in 60-year-old patients. HCV treatment became cost-effective after 9 years of starting treatment. However, if the price of DAAs is reduced by 55-85% (USD 6,730 to 17,720), HCV treatment would be cost-saving within a 5 to 20-year time horizon, which should serve to increase the uptake of DAA-based HCV treatment. The payers of health care in Japan could examine ways to procure DAAs at a price where they would be cost-saving.
Chen, Qiushi; Ayer, Turgay; Bethea, Emily; Kanwal, Fasiha; Wang, Xiaojie; Roberts, Mark; Zhuo, Yueran; Fagiuoli, Stefano; Petersen, Jorg; Chhatwal, Jagpreet
Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study. Journal Article
In: BMJ open, vol. 9, pp. e026726, 2019, ISSN: 2044-6055, ().
@article{Chen2019,
title = {Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study.},
author = {Qiushi Chen and Turgay Ayer and Emily Bethea and Fasiha Kanwal and Xiaojie Wang and Mark Roberts and Yueran Zhuo and Stefano Fagiuoli and Jorg Petersen and Jagpreet Chhatwal},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31189677},
doi = {10.1136/bmjopen-2018-026726},
issn = {2044-6055},
year = {2019},
date = {2019-06-01},
journal = {BMJ open},
volume = {9},
pages = {e026726},
abstract = {Oral direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have dramatically changed the treatment paradigm. Our aim was to project temporal trends in HCV diagnosis, treatment and disease burden in France, Germany, Italy, Spain and the UK. A mathematical simulation model of natural history of HCV infection. HCV-infected patients defined based on country-specific age, fibrosis and genotype distributions. HCV screening practice and availability of different waves of DAA treatment in each country. Temporal trends in the number of patients who achieve sustained virological response (SVR), fail treatment (by drug regimen) and develop advanced sequelae from 2014 to 2030 in each country. We projected that 1 324 000 individuals would receive treatment from 2014 to 2030 in the five European countries and 12 000-37 000 of them would fail to achieve SVR. By 2021, the number of individuals cured of HCV would supersede the number of actively infected individuals in France, Germany, Spain and the UK. Under status quo, the diagnosis rate would reach between 65% and 75% and treatment coverage between 65% and 74% by 2030 in these countries. The number of patients who fail treatment would decrease over time, with the majority of those who fail treatment having been exposed to non-structural protein 5A inhibitors. In the era of DAAs, the number of people with HCV who achieved a cure will exceed the number of viraemic patients, but many patients will remain undiagnosed, untreated, fail multiple treatments and develop advanced sequelae. Scaling-up screening and treatment capacity, and timely and effective retreatment are needed to avail the full benefits of DAAs and to meet HCV elimination targets set by WHO.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Oral direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have dramatically changed the treatment paradigm. Our aim was to project temporal trends in HCV diagnosis, treatment and disease burden in France, Germany, Italy, Spain and the UK. A mathematical simulation model of natural history of HCV infection. HCV-infected patients defined based on country-specific age, fibrosis and genotype distributions. HCV screening practice and availability of different waves of DAA treatment in each country. Temporal trends in the number of patients who achieve sustained virological response (SVR), fail treatment (by drug regimen) and develop advanced sequelae from 2014 to 2030 in each country. We projected that 1 324 000 individuals would receive treatment from 2014 to 2030 in the five European countries and 12 000-37 000 of them would fail to achieve SVR. By 2021, the number of individuals cured of HCV would supersede the number of actively infected individuals in France, Germany, Spain and the UK. Under status quo, the diagnosis rate would reach between 65% and 75% and treatment coverage between 65% and 74% by 2030 in these countries. The number of patients who fail treatment would decrease over time, with the majority of those who fail treatment having been exposed to non-structural protein 5A inhibitors. In the era of DAAs, the number of people with HCV who achieved a cure will exceed the number of viraemic patients, but many patients will remain undiagnosed, untreated, fail multiple treatments and develop advanced sequelae. Scaling-up screening and treatment capacity, and timely and effective retreatment are needed to avail the full benefits of DAAs and to meet HCV elimination targets set by WHO.
Chhatwal, Jagpreet; Chen, Qiushi; Wang, Xiaojie; Ayer, Turgay; Zhuo, Yueran; Janjua, Naveed Z; Kanwal, Fasiha
Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan. Journal Article
In: JAMA network open, vol. 2, pp. e193613, 2019, ISSN: 2574-3805, ().
@article{Chhatwal2019,
title = {Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan.},
author = {Jagpreet Chhatwal and Qiushi Chen and Xiaojie Wang and Turgay Ayer and Yueran Zhuo and Naveed Z Janjua and Fasiha Kanwal},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31074817},
doi = {10.1001/jamanetworkopen.2019.3613},
issn = {2574-3805},
year = {2019},
date = {2019-05-01},
urldate = {2019-05-01},
journal = {JAMA network open},
volume = {2},
pages = {e193613},
abstract = {Chronic hepatitis C virus (HCV) infection is a global health problem. The World Health Assembly recently pledged to eliminate HCV by 2030. However, in Pakistan, a country with one of the highest prevalence rates, the feasibility and cost of HCV elimination are not known. To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination. This decision analytical model study used a microsimulation model of the HCV epidemic in Pakistan from 2015 to 2030. Using Pakistan-specific variables, the model simulated the landscape of HCV in Pakistan and evaluated the minimum required screening and treatment rates needed to eliminate HCV in Pakistan. The study used simulated individuals chronically infected with HCV from 2015 to 2030. The analysis was performed in 2018. The status quo and 7 scenarios that can lead to HCV elimination in Pakistan by 2030, which were defined by different combinations of tests for screening, detection of viremia before treatment, and confirmation of treatment response. Temporal trends in HCV infection prevalence, mortality, and disability-adjusted life-years and total cost of HCV infection care under the status quo and scenarios that can eliminate HCV by 2030. Under the status quo, from 2015 to 2030, 1.44 million people are projected to die of HCV infection; 48% of deaths would be among people younger than 50 years. To achieve HCV elimination in Pakistan, HCV testing would need to be scaled up to at least 25 million people to diagnose 900 000 persons and treatment to 700 000 people per year. Compared with the status quo, the elimination scenario would avert 323 000 liver-related deaths and 13.0 million HCV-associated disability-adjusted life-years from 2015 to 2030. The elimination scenario was associated with cost savings of $2.6 billion from 2018 to 2030 with use of a point-of-care test for population-wide antibody screening and detection of viremia and treatment response. Substantial scale-up of HCV testing and treatment may be essential to eliminate HCV infection in Pakistan, and such a strategy may be associated with cost savings in the near future. Although HCV elimination in Pakistan may be ambitious, strategic planning and strong support from the government may aid in its elimination.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chronic hepatitis C virus (HCV) infection is a global health problem. The World Health Assembly recently pledged to eliminate HCV by 2030. However, in Pakistan, a country with one of the highest prevalence rates, the feasibility and cost of HCV elimination are not known. To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination. This decision analytical model study used a microsimulation model of the HCV epidemic in Pakistan from 2015 to 2030. Using Pakistan-specific variables, the model simulated the landscape of HCV in Pakistan and evaluated the minimum required screening and treatment rates needed to eliminate HCV in Pakistan. The study used simulated individuals chronically infected with HCV from 2015 to 2030. The analysis was performed in 2018. The status quo and 7 scenarios that can lead to HCV elimination in Pakistan by 2030, which were defined by different combinations of tests for screening, detection of viremia before treatment, and confirmation of treatment response. Temporal trends in HCV infection prevalence, mortality, and disability-adjusted life-years and total cost of HCV infection care under the status quo and scenarios that can eliminate HCV by 2030. Under the status quo, from 2015 to 2030, 1.44 million people are projected to die of HCV infection; 48% of deaths would be among people younger than 50 years. To achieve HCV elimination in Pakistan, HCV testing would need to be scaled up to at least 25 million people to diagnose 900 000 persons and treatment to 700 000 people per year. Compared with the status quo, the elimination scenario would avert 323 000 liver-related deaths and 13.0 million HCV-associated disability-adjusted life-years from 2015 to 2030. The elimination scenario was associated with cost savings of $2.6 billion from 2018 to 2030 with use of a point-of-care test for population-wide antibody screening and detection of viremia and treatment response. Substantial scale-up of HCV testing and treatment may be essential to eliminate HCV infection in Pakistan, and such a strategy may be associated with cost savings in the near future. Although HCV elimination in Pakistan may be ambitious, strategic planning and strong support from the government may aid in its elimination.