Estimating the impact of test-and-treat strategies on hepatitis B virus infection in China by using an age-structured mathematical model

Zu, Jian; Li, Miaolei; Zhuang, Guihua; Liang, Peifeng; Cui, Fuqiang; Wang, Fuzhen; Zheng, Hui; Liang, Xiaofeng

doi:10.1097/md.0000000000010484

Cited by 14 publications

(12 citation statements)

References 25 publications

(62 reference statements)

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“…389,390 Future efforts to reduce hepatitis-related morbidity and mortality in China should focus on preventive strategies, safe blood practices, public education, and training health staff for large-scale HBV and HCV testing and treatment provision. 391 A strict action plan to reduce the harmful use of alcohol such as an excise tax on beer, wine, and spirits, and legally binding regulations on alcohol advertising should be implemented. The Government should also implement an operational policy to reduce unhealthy dietary practices and promote physical activity to prevent NAFLD.…”

Section: Priorities To Address the Burden Of Liver Diseases In The Asmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

411

303

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The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

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Section: Priorities To Address the Burden Of Liver Diseases In The Asmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

411

303

View full text Add to dashboard Cite

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“…Several previous HBV modeling studies have evaluated the epidemiology of chronic HBV infection in China [ 17 – 19 ]. Those studies found that increased screening and treatment were effective in reducing chronic HBV infection, and enhanced vaccination was beneficial in eliminating transmission.…”

Section: Introductionmentioning

confidence: 99%

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

Zheng

Ding

et al. 2020

Virol J

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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.

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“…According to the POLARIS modeling study, in the mainland of China, only around 20% of those chronically infected with HBV were actually diagnosed and and 10% of those who were eligible to be treated received treatment (45). Investment case modeling studies suggested that if we only treat the few millions of CHB who are already on the treatment, the HBV-related cirrhosis/HCC mortality will still be increasing over the next two decades; on the other hand, if we scale up test-and-treatment strategies and treat most or even all persons who need the treatment, the HBV-associated mortality will dramatically decline, which is cost-effective or even cost-saving (46). For example, if the treatment coverage increased from current practice (12.5%) to 100% from 2018, the numbers of chronic HBV infections, new HBV infections, and HBV-related deaths in 2035 would be reduced by 26.60%, 24.88%, and 26.55%, respectively, and in 2050, it would be reduced by 44.93%, 43.29%, and 43.67%, respectively (47).…”

Section: Perspective On the Massive Test-and-treat Strategymentioning

confidence: 99%

Control of Chronic Hepatitis B in China: Perspective of Diagnosis and Treatment

Wang

Wang²,

Zhang

et al. 2020

China CDC Weekly

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Estimating the impact of test-and-treat strategies on hepatitis B virus infection in China by using an age-structured mathematical model

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 25 publications

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

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

Control of Chronic Hepatitis B in China: Perspective of Diagnosis and Treatment

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