Health Economic Outcomes of a Minimal Monitoring Approach to Providing HCV Therapy
A minimal monitoring approach to providing HCV therapy resulted in cost savings compared to a simulated standard of care.
In a new article in Hepatology Communications, lead author and CHERISH Population Data & Modeling Core Director Benjamin Linas and colleagues report new economic analyses from MINMON, an AIDS Clinical Trial Group (ACTG 5360) study that used a minimal monitoring approach to provide treatment for chronic hepatitis C virus (HCV). Findings suggest that the simplified HCV care delivery model, which required no on-site medical visits or lab monitoring, offers cost savings at the program and health sector level.
The MINMON trial was conducted in five countries, Brazil, South Africa, Thailand, Uganda, and United States, and enrolled 400 individuals living with HCV. The trial provided participants with a 12-week HCV treatment course at an initial visit and asked them to return for an evaluation 12 weeks after they completed their treatment. This simplified care model yielded a high proportion of 95% sustained virological response (SVR), in which the virus remained undetected and the individual is considered cured.
To inform the implementation of the MINMON care model, authors conducted an economic analysis alongside the MINMON trial to calculate the cost per SVR. Researchers collected health care utilization data and examined the economic costs from the perspectives of the program and health sector. The team used micro-costing methods to calculate costs and simulated a hypothetical standard of care model to compare the cost per SVR.
Key Findings
MINMON had a lower cost per cure than the simulated standard of care, especially in low- and middle-income countries.
- In the MINMON trial, the cost per cure from the program perspective ranged from US$1,682/SVR (Thailand) to US$27,632/SVR (United States). The cost per SVR from the health sector perspective ranged from US$6,273/SVR (South Africa) to US$123,974/SVR (United States). The cost of standard of care medications was highest in the US and lowest in Thailand.
- MINMON had a lower cost per cure than standard of care in all scenarios in Brazil, South Africa, Thailand and Uganda. In the United States, the MINMON cost per SVR was lower as long as the SVR rate for standard of care was 95% or less, taking into account loss to follow-up.
This comparison of US and non-US sites has implications for HCV elimination models in the United States. As the cost of medications comes down, the relative contribution of labs and visits to the cost of HCV treatment increases, and MINMON becomes increasingly economically attractive. The important finding is that MINMON is likely a cost-saving strategy in the US, but attention to retention in care is essential in both strategies to minimize poor clinical and health economic outcomes.
Benjamin Linas, MD, MS, Infectious Disease Physician at Boston Medical Center
MINMON is a cost-saving strategy for HCV treatment, particularly in low- and middle-income country settings.
Simplifying treatment delivery for chronic HCV is a high priority in countries that lack diagnostic testing and lab facilities and are home to populations living with HCV. Findings from this study support low-threshold HCV treatment models like MINMON, which demonstrated cost savings to countries across low-, middle-, and high-income settings. Based on the economic analyses, authors conclude that as the cost of HCV medication declines, a universal MINMON approach can help meet the World Health Organization 2030 HCV elimination goals of reducing new HCV infections and deaths.
The study, “Health economic outcomes of a minimal monitoring approach to providing HCV therapy,” was published in Hepatology Communications in May 2025.