Extending treatment eligibility for chronic hepatitis B virus infection

McNaughton, Anna L; Lemoine, Maud; Rensburg, Christo van; Matthews, Philippa C.

doi:10.1038/s41575-020-00398-x

Cited by 36 publications

(29 citation statements)

References 44 publications

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“…All those chronically infected are at increased risk for developing cirrhosis and liver cancer (European Association for the Study of the Liver, 2017). The advent of safer and more efficacious HBV antivirals has expanded the indication for treating almost all chronic HBV carriers (McNaughton et al 2021). A major challenge, however, is keeping patients on daily drug medications for years.…”

Section: Hbvmentioning

confidence: 99%

Ultra-long-acting (XLA) antivirals for chronic viral hepatitis

Soriano

Alvarez

Edagwa

et al. 2022

International Journal of Infectious Diseases

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Section: Hbvmentioning

confidence: 99%

Ultra-long-acting (XLA) antivirals for chronic viral hepatitis

Soriano

Alvarez

Edagwa

et al. 2022

International Journal of Infectious Diseases

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“…Antiviral medications are essential for the successful treatment of hepatitis. Implementing NVBP may help reduce disease transmission and achieve UN goals ( McNaughton et al, 2021 ). Individuals with HBV may experience both personal and societal impacts, including anxiety, financial burden and instability, discrimination, and stigma ( Tu et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Aimed at reducing global HBV incidence by 90% and mortality by 65%, the UN’s Sustainable Development Goals have set ambitious targets, projecting these to be achieved by 2030 ( McNaughton et al, 2021 ). Generally, effective vaccines and supportive care are recommended for preventing and managing of Hepatitis B.…”

Section: Introductionmentioning

confidence: 99%

“…Persistent inhibition of HBV replication by antiviral therapy has been shown to be able to prevent chronic HBV‐induced progressive fibrosis, cirrhosis, and HCC ( Lampertico et al, 2015 ; Papatheodoridis et al, 2015 ), achieving the ultimate goal of improved survival and quality of life for most HBV patients ( Vlachogiannakos and Papatheodoridis, 2018 ). Through wider use of antiviral therapy and expansion of HBV treatment eligibility, potential public health benefits in reducing transmission may be achieved as suggested by McNaughton AL and colleagues ( McNaughton et al, 2021 ). However, antiviral therapy can be costly, resulting in increased economic burden and limited access to such essential medications.…”

Section: Introductionmentioning

confidence: 99%

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Impact of National Volume-Based Procurement on the Procurement Volumes and Spending for Antiviral Medications of Hepatitis B Virus

et al. 2022

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Introduction: Although persistent inhibition of HBV replication by antiviral therapy has shown to slow disease progression, cost-related access barriers to these essential medicines are becoming salient. The national volume-based procurement (NVBP) was piloted in China and led to substantial reduction in the list price of prescription drugs. To examine the impact of NVBP on selected antiviral medication costs per defined daily dose (DDD), procurement volumes, and spending.Methods: We employed an interrupted time series design to examine changes in cost per defined daily dose (DDD), procurement volumes, and spending for NVBP bid-winning antiviral medications (tenofovir disoproxil fumarate and entecavir) in 11 pilot cities from 2017 to 2020. Procurement transaction data were obtained from 9,454 hospitals in the Chinese Hospital Pharmaceutical Audit (CHPA) database. In the secondary analysis, the control group comprised two non-NVBP drugs (adefovir and lamivudine) procured in 11 cities not exposed to the NVBP.Results: Cost per DDD of the two hepatitis B virus (HBV) antiviral medications reduced by CNY1.598 (p = 0.002) immediately following the implementation of NVBP, dropping from an average cost of CNY16.483 per DDD at baseline to CNY6.420 at the end of the observation period. NVBP implementation resulted in a substantial reduction in daily costs of antivirals and an increase in monthly procurement volumes by 6.674 million DDDs (p = 0.017), while monthly spending was reduced by CNY138.26 million (p = 0.002). In the secondary ITS analysis with a control group, the average cost per DDD of the NVBP bid-winning antivirals declined by CNY4.537 (p < 0.001), monthly procurement volumes increased by 7.209 million DDDs (p = 0.002), and monthly spending dropped by CNY138.83 million (p < 0.001).Conclusion: Volume-based procurement piloted in China may be effective for reducing price and total expenditures and improving drug utilization, which is especially important for HBV patients who need constant access to antiviral therapies.

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“…Traditionally, HBV infection has been classified based on serology, VL, and markers of liver damage (such as liver enzyme levels, imaging scores and/or liver biopsy) 105 . Guidelines for nucleoside/nucleotide analogue (NA) therapy, based on these biomarkers together with age and sex, typically consider ~1 in 4 individuals with CHB treatment-eligible, although this varies between populations 106 . However, there is increasing recognition that current classification systems over-simplify liver disease by applying a traditional paradigm of linear progression, and that untreated individuals have a risk of progressive liver disease and HCC, and may also be at risk of transmitting infection [106][107][108][109] .…”

Section: Sex To Inform Hbv Interventions 51 Sex To Inform Stratificat...mentioning

confidence: 99%

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

Brown¹,

Goulder²,

Matthews³

2022

Wellcome Open Res

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Sexual dimorphism in infectious diseases refers to the different infection susceptibilities and outcomes between males and females, and has been described for many pathogens, including hepatitis B virus (HBV) infection. HBV is a substantial global health problem, with close to 300 million people infected, and accounting for a million deaths each year, with an urgent need for enhanced interventions to support progress towards elimination goals. Sexual dimorphism has a strong influence in HBV infection, with males more likely to be exposed, to develop chronic infection, and to suffer from complications including cirrhosis and hepatocellular carcinoma (HCC) compared to females. Different outcomes are driven by differential immune responses, sexual dimorphism of the liver, and androgen response elements in the HBV genome. The impact of sex may also vary with age, with changes at puberty and influences of menarche, pregnancy and menopause in females. In addition, gender has complex influences on education, beliefs, behaviour and access to / engagement with healthcare services, which may contribute to differences in diagnosis and treatment. Interplay between these complex factors, alongside other attributes of host, virus and the environment, accounts for different outcomes of infection. However, gaps remain in our understanding of sexual dimorphism in HBV, and little effort has previously been made to harness this knowledge for translational gains. In this review, we assimilate human and animal data to consider the mechanism, outcomes and impact of sexual dimorphism, considering how these insights can be used to inform advances in surveillance, treatment and prevention for HBV infection.

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Extending treatment eligibility for chronic hepatitis B virus infection

Cited by 36 publications

References 44 publications

Ultra-long-acting (XLA) antivirals for chronic viral hepatitis

Ultra-long-acting (XLA) antivirals for chronic viral hepatitis

Impact of National Volume-Based Procurement on the Procurement Volumes and Spending for Antiviral Medications of Hepatitis B Virus

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

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