Long-term clinical benefits of Sofosbuvir-based direct antiviral regimens for patients with chronic hepatitis C in Central and West Africa.

Background In Sub-Saharan Africa, chronic hepatitis C (CHC) is a major public health issue. We estimated the long-term clinical benefits of treating CHC with sofosbuvir-based regimens in Cameroon, Cote d'Ivoire and Senegal using Markov model combining data from the literature with estimates of direct antiviral agents (DAAs) effectiveness in West and Central Africa. Methods Disease progression was simulated with and without treatment in fictive cohorts of patients "diagnosed" with CHC in Cameroon (n=3224), Cote d'Ivoire (n=9748) and Senegal (n=6358). Lifetime treatment benefits were assessed using i) life-years saved (LYS), ii) life-years (LY) avoided in compensated cirrhosis (CC), decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), iii) comparison of the proportions of patients at each disease stage with and without treatment. Probabilistic and determinist sensitivity analyses were performed to address uncertainty. Results Sofosbuvir-based treatment would save [mean, 95% Confidence Intervals] 3.3 (2.5;5.7) LY per patient in Cameroon, 2.7 (2.1;4.8) in Cote d'Ivoire and 3.6 (2.8;6.3) in Senegal. With treatment, approximately 6% (1%) of the patients still alive in each of the study countries would be in the CC (DC) health state 11 (15) years after CHC diagnosis, versus 15% (5%) without treatment. Scenario analysis showed earlier diagnosis and treatment initiation would dramatically improve LYS and morbidity. Conclusion Sofosbuvir-based treatment could significantly reduce CHC-related mortality and help control CHC-related liver disease progression in West and Central Africa. However, the goal of disease elimination necessitates a substantial decrease in DAAs prices, greater political commitment, and increases in both national and external health expenditures.