Treatment and Cost -outcomes of a simplified antiretroviral treatment strategy for hepatitis C among HCV and HIV co-infected patients in Ukraine

Background: We conducted a demonstration project of an integrated HIV and viral hepatitis testing and treatment strategy using generic ledipasvir/sofosbuvir (LDV/SOF). Methods: Eligible HCV viraemic adults from two clinics in Kyiv were treated with LDV/SOF +/- weight-based ribavirin for 12 weeks. Clinical assessments were performed at screening and week 24 and as needed; treatment was dispensed every 4 weeks. The primary outcome was sustained virologic response (SVR)12 weeks after treatment. Program costs in 2018 USD were estimated per patient treated using observed resource utilization, local unit, and antiretroviral therapy (ART) costs over the 24-week period. Results: 868 participants initiated on treatment, 87% (755) were PWID and 55.5% (482) were HIV co-infected. The common genotypes were 1 (74.1%) and 3 (22%) and SVR was achieved in 831/868 (95.7%) by intention-to-treat analysis. The average cost per patient treated was $680, assuming generic LDV/SOF and ribavirin pricing and standard quantitative HCV viral load testing. Medications comprised 38% of the average cost/patient, laboratory tests 26%, events (clinic visits, counselling) 10%, and indirect costs 26%. ART accounted for 60% of all drug costs, with HCV medications just 40%. Conclusion: Generic LDV/SOF +/- ribavirin provided produced exceptionally good outcomes including amongst patients with genotype 3 HCV and PWID at an average cost of <$700/patient year, including ART for those with HIV. Under the assumptions of generic drug pricing but higher laboratory costs, an average cost of $750/patient is likely a reasonable estimate for this intervention in Ukraine, excluding costs for scaling or maintaining the treatment program.