Disease burden of chronic hepatitis B and complications in China from 2006 to 2050: an individual-based modeling study

Abstract

Background: Chronic hepatitis B has become a major public health problem in China. An accurate depiction of the disease burden has not yet been thoroughly conducted. We aimed to project the disease burden of chronic hepatitis B virus (HBV) infection and related complications by modeling various scenarios. Method: An individual-based Markov model was used to predict disease burden from 2006 through 2050. We simulated 5 scenarios with different annual incidences, diagnoses and nucleotide analog (NA) treatment rates as well as treatment eligibility, which included a natural history without diagnosis or NA therapy, a base case, a World Health Organization (WHO)-proposed target case and two ideal cases. Result: The natural history scenario is projected to have the fewest HBsAg losses (27.59 million) and highest number of HBV-related deaths (27.19 million). With improved diagnosis and treatment rates of NA therapy, ideal cases have fewer HBV-related deaths (14.46-14.77 million) than do WHO-proposed cases (15.13 million) and base cases (16.89 million), but the proportion of HBsAg loss is similar among them. With a reduction in new infections, the prevalence of chronic HBV in 2050 is expected to be a minimum of 27.03-27.49 million under WHO and ideal cases. Conclusion: Ideal scenarios 1 and 2 contribute to the lowest disease burden of HBV and its complications in the future, in which new infection control is more effective than increasing diagnosis, treatment rate and treatment eligibility. However, considering the large existing chronic HBV infected population and the low HBsAg loss rate of NA therapy, it is still difficult to avert the increasing trend of cumulative cirrhosis, DC, HCC, LT, and HBV-related death in all scenarios. If new high-potency drugs are not developed, the disease burden of chronic HBV will remain high in the future.

Trends of Phase I Clinical Trials of New Drugs in Mainland China Over the Past 10 Years (2011–2020)

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Conventional and genetic risk factors for chronic Hepatitis B virus infection in a community-based study of 0.5 million Chinese adults

“…Improving the identification of chronically infected individuals is a key component to addressing the chronic HBV burden in China 6 . It is described as a ‘silent epidemic’ 1 reflecting the asymptomatic disease course that contributes to late diagnosis and poor prognosis – in China the diagnosis rate is estimated at less than 20%, well below the World Health Organization (WHO) target of 90% by 2030 7 , 8 . However, apart from risk factors contributing to mother to child transmission, comparatively little is known about risk factors for HBV chronicity in adults, and the most recent nationwide Hepatitis B serosurvey in China in 2014 only included participants aged 1–29 years 9 .…”

In-patient Expenditure Between 2012 and 2020 Concerning Patients With Liver Cirrhosis in Chongqing: A Hospital-Based Multicenter Retrospective Study

“…China has the greatest disease burden of liver cirrhosis in the world ( 9 ). In China, the number of patients with liver cirrhosis accounts for 20% of the total number of patients with chronic liver disease, most of whom are aged between 20 and 50 years ( 10 ).…”